At this time, about 63% of Americans are part of the labor force.  Many employers offer programs designed to promote wellness and connect individuals with treatment options.  In addition, they promote the ability to handle and reduce stress. 
 
The CDC (Centers for Disease Control) reports that 1 in 5 adults (18 and older) reported suffering from mental illness in 2016.  Additionally, 71% reported headaches, feelings of being overwhelmed, or anxiety, all overt symptoms of stress. 
 
Mental health disorders are also closely linked to other physical conditions like heart disease, diabetes, and muscular problems.  Treating the physical and mental disorders separately will cost two to three times more than treating those without combination issues.  By combining the treatment plans, the savings could amount to $37 billion to $67 billion each year.  This means employers can reduce health care costs across the board and have healthier employees.
 
Further, the CDC says that employees with a high risk of depression had the highest health cost during a three year period following the initial assessment.  This includes others at risk from smoking and obesity.  Depression will affect performance at least 20% and affects cognitive abilities about 35%.  However, of those who report moderate depression only 57% receive treatment and for those with severe depression only 40%.
 
Excess stress and other mental health issues translates to negatively affecting:

• Job performance
• Productivity
• Interactions with other employees
• Communication
• Physical issues
• Functionality

 
Especially when mental and physical treatment plans are combined, employer sponsored wellness programs have proven beneficial to both the company and the employees.  Through a combined plan:

• Communications can be combined using the structures already in place
• Social networks become available
• Programs and policies are united
• Offering incentives for healthy behaviors
• Employers can track progress

 
As an employer you have some options.

• Offer self-assessment mental health tools
• Establish clinical screenings by qualified mental health professionals with clinical referrals as appropriate.  These can be free to the employee or offered at a reduced cost.
• Reduce co pays on depression medications
• Programs for lifestyle changes
• Host in-office programs to discuss stress reduction techniques
  • Breathing exercises
  • Meditation
  • Mindfulness
  • Focus improvement
• Treat disrespectful comments or actions as you would any other form of prejudice or discrimination
• Provide managers and supervisors with the tools to identify signs of stress and depression
• Give employees the opportunity to voice opinions

 
There are a number of insurers who provide plans to help implement a mental health program.  This can include videos, emails, education and other initiatives to help management and employees deal with the issues in the workplace.

​The CDC (Centers for Disease Control) estimates that 20% of adults over the age of 55 will experience some form of mental health disorder.  This can include some sort of cognitive issue (forgetfulness all the way to some degree of dementia), mood swings (generally depression), and anxiety. 
 
With depression as the most common form of mental disorder in seniors, it can affect social interactions and impair the ongoing treatment of other chronic conditions.  It is often dismissed as a normal part of aging or under treated. 
 
In reality, depression or other mental illnesses are not a normal part of the aging process.  Left untreated, it will affect the person's ability to function, lead to a poorer quality of life, and can actually slow the healing from physical illnesses and surgeries.
 
Mental health can easily decline after a serious illness like stroke or chronic conditions like Parkinson’s, arthritis, or cancer.  Medication can often play a part with drug interactions between prescriptions that are overlooked.  Older adults have needs that change including loss of friendships, relocating to other parts of the country, and changes in living conditions.  All of this needs to be considered during the treatment of mental health issues.
 
The good news is that older adults can be helped with the same success as those who are younger.  With some psychotherapy and anti-depressant medication, it is reported that 80% will recover.
 
Some symptoms you may want to watch for include:

• Sadness that persists.  If the person remains depressed longer than two weeks, keep tabs to see if it is improving.  If not, consider help with a mental health professional.
• Consistent sleep issues
• Trouble concentrating
• Everyone forgets things.  However if it becomes consistent, occurs more frequently, or in familiar surroundings, start paying closer attention.
• Over use of alcohol
• Confusion with the medication regimen

If these indicators accumulate or become more serious, it is a sign that the individual may need some professional help.
 
Many older adults continue to thrive even on their own.  Some habits that seem to help are:

• Exercising to the best of their physical ability.  This can include gardening in raised beds, walking, dancing, etc.
• Reading.  Joining with others to discuss books is a good way to stimulate mental agility.  Reading as a group event allows for socializing and forces people to read something they would not normally pick up.  There are a number of websites that offer discussion questions.  Check with your local public library for suggestions.

 
The health system in the United States offers Medicare that covers 80% of a physical health issue but only 50% for a mental health condition.  Fear of overspending can often impact an older adult's reluctance to seek mental health assistance.  Studies have shown that over 60% of older adults with a mental health issue will not receive the help necessary to bring them back to a stable head space.

As a concerned family member or as part of the medical team, it is critical to review prescriptions and over-the-counter medications.  This has a two-fold importance:  to be sure the prescribed medication is taken as ordered and to review for any interactions.  

Older adults often visit more than one medical professional.  Most older adults are quite capable of managing their medical care and are conscientious about complying with the medication instructions. However, when multiple prescriptions are involved, medical staff should carefully review all of them. Overprescribing is rampant for older adults who are more vulnerable for adverse effects.

As one ages, the liver becomes less able to break down medications and toxins.  Side effects can become more common if medications are not initiated and titrated slowly.  Lower doses may be utilized compared to younger adults.

At some point, cognitive abilities will fail and it will be necessary for someone else to take responsibility for the medications.
​

The chance of dementia increases with age: 

• 5% of all adults over 65
• 30% in adults in the mid 80s
• over 50% for adults in their 90s. 

While Alzheimer's is the most common form, there are other types of dementia to be screened for.
​
Symptoms like depression, anxiety, and insomnia are often overlooked as changes in cognitive abilities. Wandering will occur in over 90% of patients diagnosed with dementia and is the primary concern for their caregivers.  With supportive guidance to the patients and families, this condition can be dealt with reasonably and safely.  Of primary concern is safe judgment and appropriate living arrangements.

If you know someone who may need some help, don't delay, book an appointment today. 
 ​

A psychiatrist is a medical doctor (M.D.) who becomes specialized to effectively treat mental health issues. If you're wondering how to become a psychiatrist, there are a few vital steps to take.

Psychiatrists diagnose, treat, and help prevent emotional and behavioral disorders. To do this they will use a number of techniques or methods including therapy, interventions, and medication.
​

​To become a psychiatrist, you must first have a bachelor’s degree from an accredited institution. These degrees are often in the pre-med area, psychology, sciences, or a combination.  The degree does not have to be science related though.  Any degree with the appropriate pre-requisites will suffice.  Academic advisors can help develop a program of classes to keep you on track.

Psychiatrists are medical doctors, so it is necessary to start with the MCAT (medical college admissions test), get admitted to a MD or DO Program.  After graduating medical school (4 years), begins years of clinical residency.  For psychiatry, the standard general residency is four years.  Many psychiatrists will work additional years to sub-specialize.  

In order to practice any type of medicine, physicians must be licensed in the state(s) in which they will work.  This includes psychiatrists.  This license must be maintained in good standing which will include continuing medical education credits and renewal.

While in college and during residency, the individual usually settles on a specialty in which he or she wishes to practice.  The classes and clinical work should focus on those areas.  The choices include:

• Behavioral Science – This focuses on human behavior involving emotions, personality, and social actions.  It involves biochemical, pharmacological, and physiological personality actions and traits.
• Cognitive, Affective, and Behavioral Neuroscience – This deals with neurological components that explain how people think, remember, make decisions, and deal with emotions.
• Psychopathology – This deals with serious disorders and how they can be treated.  It also explores the legal and ethical elements of the treatments.  Frequently it delves into multicultural influences

Psychiatrists work with patients either in private practice, in a hospital, or other institutional setting.  Away from the patient, they review and record notes and assure that treatment protocols are being followed.  They may meet with patients' families, support groups, or other interested parties.

Specialization can involve illnesses like anxiety or sociopathy, or with a demographic element like children, older adults, or veterans.  In some cases the working hours are very regular, but it is not unusual for psychiatrists to work extended hours in some settings.
  
There are a number of historical issues that influence the treatment and those who are seeking help.  Psychiatrists help dispel myths and stigmas and promote healthy mental and physical outlooks for their patients.

The psychiatrist will also need to understand the brain and how it works.  People perceive and process information in different ways and the interrelationship of the nervous system and behavior becomes critical in many cases.

Communication skills are particularly important in psychiatry.  How someone explains their symptoms and digging out the details can make a big difference when it comes to making the correct diagnosis.  Better care is often provided after a thorough evaluation.

Tele-medicine is the provision of health care remotely through the use of technology. Telehealth psychiatry is a method to provide a range of services including:

• Evaluation
• Therapies
• Individual
• Group
• Family
• Education
• Medication management

​Although it uses video-based electronics, telehealth psychiatry involves direct care between the psychiatrist and patient. Telehealth is a live interactive method for a doctor to provide needed mental health service to remote patients. It can also be used to transmit medical information to other consultants.

• Brings accessibility to rural areas
• The care is brought directly to the patient
• Incorporates mental health care along with primary medical services
• Allows for continual follow-up services
• Reduces barriers like transportation, child care, etc.
• Provides a confidential and convenient service

Telehealth psychiatry provides a needed service in what might otherwise be an underserved area due to access  or safety concerns. It is a cost effective method to offer aid to patients in privacy. The psychiatrist must be licensed in the states they are working, and can only provide care for patients in those states.
It is used in a number of different settings:

• Military
• Nursing homes
• Correctional facilities
• Schools
• Nursing Homes
• Clinics and hospitals

Experts estimate that 1/8 emergency room visits require a psychiatric intervention. Electronic Psychiatry visits can help evaluate the patient and offer treatment options. Nursing homes and long-term care facilities use telehealth psychiatry appointments to provide mental health treatment without compromising accessibility. Those in jail and prison can now also receive valuable psychiatric treatments for ongoing mental issues.

For the ordinary individual, they will schedule an appointment for a video appointment. However, it is suggested that, if at all possible, the patient should be prepared for an in-person appointment. The individual should have all relevant information, medical records, medications, and other materials readily accessible.  
Research is showing that telehealth psychiatry visits are equivalent to in-person appointments. Diagnoses are just as accurate, treatments are as effective, and patients show a high degree of satisfaction. Privacy and confidentiality are still maintained to standards or greater.

For people with severe anxiety disorders or those with mobility issues, remote treatments have proven highly beneficial. 
 
When considering a telehealth psychiatry appointment, it is important to find a secure place for your appointment. The psychiatric team will be responsible for their location. Be sure to verify the software works and you have a working internet connection. While many devices and operating systems offer secure software, not all do.

How often has mom told us “eat a little something and you will feel better”?  Think about it...your brain never stops working.  All day and all night, your brain keeps your bodily functions operating.  Using all that energy requires constant fuel.  What you eat directly affects your bodily functions, including the brain.  So the better you eat, the better your brain will work.  Conversely, when you overeat, or consume junk food, or otherwise skimp on nutrition, you are prone to sadness and anxiety.


This is the basic principle of nutritional psychiatry.


Today's research is showing a correlation between good nutrition and the reduction of free radicals, inflammatory cells, the kinds of bacteria that live in the intestinal tract, as well as how you feel, and behave.  Eating highly refined sugars is now linked to impaired brain function and the aggravation of mood disorders like depression.  Nutritious foods with vitamins, minerals, and antioxidants protects the brain from oxidative stress or free radicals produced as the body oxygenates.


Serotonin is a substance, a neurotransmitter, that regulates sleep, appetite, evens out moods, and reduces pain.  The vast majority of serotonin is produced in the gastrointestinal organs.  So there is a direct connection between the transmitters in the gut and the serotonin that keeps our lives on track.  As proper nutrition is processed by the body, it helps regulate our moods as well.


Studies have found that the risk of depression is lowered by 25% to 35% in persons who follow a Mediterranean or Japanese diet.  These eating plans are high in vegetables, fruits, unprocessed grains, and fish and low in meats and dairy.  They also shun processed and refined sugars and other foods.


A food diary is an easy way to see if it works.  Try one of these diet plans and after about a week start keeping a record of what you ate through the day and then how you felt the next day.  Continue this for another week and see if there is a change in your mental attitude.  This is also a way that you can find trigger foods by reintroducing them into your eating plan and then tracking how your emotions are affected.  Also note if you have increased or decreased energy and sleep patterns.


Nutritional psychiatry is applying these studies to patients who suffer from various forms of mental illness especially anxiety and depression.  It appears to be an effective method to reduce or eliminate medications that can have other side effects that adversely affect some people. 


Combining healthy eating with approved psychiatric counseling sessions is one of the non-invasive techniques that can greatly improve lives. 


A 2020 study has revealed that anti-inflammatory fats like Omega-3 are connected to a lower risk of depression.  This study found that women who consumed fish twice per week had a 25% lower risk of depression as compared to those women who ate fish less than twice per week.


Higher risk of depression was found in people who failed to get enough magnesium (beans, lentils, peas, avocado, nuts, whole grains, and dark chocolate).  The same was found in those who were deficient in zinc (oysters, pumpkin seeds, cashews).

Stress is an emotional strain that comes as a result of difficult or adverse circumstances.  It is an emotional response to external factors but can have physical symptoms as well.  Some of the physical issues are:

• Digestive problems
• Reproductive issues
• Muscle tension
• Headaches
• Fatigue
• High blood pressure
• Chest Pain

 
Mental health issues include:

• Anxiety
• Irritability
• Depression
• Anger
• Feeling overwhelmed
• Racing thoughts
• Worry
• Making bad decisions

 
Situations that cause us concern are called stressors.  Stressors can be negative like relationship issues or financial problems.  Stressors are also internal like pessimism about life, worrying about something that may or may not happen or self perception.
 
Stress is basically our perception of something difficult to deal with.  Stressors are somewhat individualized in that what may bother one person has no affect on another.  Strict deadlines may have you in a tizzy but  your coworker thrives in that atmosphere.  Common external stressors are:

• Major life changes (good or bad)
• Work or school
• Relationships
• Finances
• Overworked
• Commitments including family

 
Internal issues include:

• Lack of flexibility
• Pessimism
• Negative self image
• Unrealistic expectations

 
There are some indicators to show that you are having difficulty dealing with stress:

• Work or school performance drop
• “Self medicating” with alcohol, drugs, or tobacco or an increased use of any of them
• Difficulty dealing with daily situations
• Withdrawal from friends, family, or social situations
• Sudden irrational outbursts
• Taking dangerous chances
• Thinking of hurting yourself or others

 
There are definitely some ways you can learn to adapt or handle the stress in your life:

• Activity – Regular exercise can make you feel better.  Rhythmic pursuits like walking, dancing, and swimming are some of the best choices, especially if you try to focus on the sensations around you.  Park further from the entrance and enjoy a brisk walk into the building.  Turn on your favorite tunes and dance around the home.  Greet people you see along the way.  When you go out for a smoke break, just once per day, walk around the building instead.
• Interactions – Instead of texting, look up and speak to someone.  If your friends make you more anxious or worried, spend less time with them.  If you are trying to build some friendships, there are many free activities.  Try your local library movie night and join in the discussions afterward.
• Healthy eating – A diet of processed and convenience food, sugary snacks, and refined carbohydrates will only worsen the situation.  Eating good, lean protein, fruits, vegetables, reducing caffeine and sugar and drinking enough water every day will help you feel physically better and then more capable of handling the challenges that come your way.

 

In the clinical world of mental health, a sociopath and a psychopath are each classified as someone with antisocial personality disorder (ASPD).  These are individuals who cannot understand others' feelings.  In general, they have no guilt for doing harm.  They may be charming.  The terms sociopath and psychopath are often debated in academic circles, and many consider them to be the same thing.  Others apply small differences to the conditions.  
 
Shared behavior between sociopaths and psychopaths are:

• Disregard for laws
• Disregard for social rules or patterns
• Disregard for the rights of others
• No remorse
• No guilt
• Aggressive or even violent behaviors

 
Being selfish, acting out, or acting rebelliously are not, in themselves, cause for a diagnosis of ASPD.  However, if the symptoms are ongoing and are not altered by punishment or changes in lifestyle, the outcome is often different.  People with ASPD rarely if ever feel bad about what they are doing or how they are treating others. 
 
Sociopaths are generally nervous and can burst into anger easily.  They have few acquaintances and probably few to no friendships because they have difficulty maintaining relationships.  As a rule, they are less educated and frequently live on the fringes of society.  Crimes they commit are generally spontaneous. 
 
Psychopaths are very charming people and find it easy to manipulate others.  Because they are so charismatic, they seem disarming.  They are usually well educated and hold steady jobs.  While they do not form relationships, they learn how to imitate emotions.  They appear normal.  For this reason it can be difficult for a victim to realize they have been targeted.  Their crimes are very well planned and executed and plan for contingencies.
 
Psychiatric diagnoses usually center on the “nature versus nurture” theory.  Psychopaths are genetically predisposed to their behavior, while sociopaths are developed from childhood trauma or abuse.
 
To be diagnosed with ASPD, an individual over 18 must clearly demonstrate at least three of the following behaviors. 

• Clear disrespect for social norms and laws.
• Lies, uses false identities, and uses others for personal gain.
• Avoids long-term plans; ignores consequences.
• Aggressive behavior like frequent fights.
• Ignores personal safety or that of others.
• Ignores personal responsibilities like work habits or paying bills
• Has no guilt or remorse for actions.

 
Other indicators can be:

• Not learning from mistakes
• Threats and intimidation
• Frequent crimes
• Unwarranted risks
• Substance addiction
• Inability to maintain relationships
• For individuals younger than 15, animal abuse or cruelty

 
Both psychopaths and sociopaths are a risk to society and a danger to others in many cases.  Violence is not a required element for a diagnosis of ASPD but it is often found as a trait in those who have been so diagnosed.  Because of their ability to dissociate from others and lack of remorse, psychopaths are typically the more dangerous of the two.  Many convicted serial killers have been diagnosed as psychopaths.
 
Not everyone who has an antisocial personality disorder is a psychopath or a sociopath.  It is estimated that as much as 3% of the population has ASPD.  It is more common in males, those with substance abuse, and in prisons.

A psychiatrist is a physician, medical doctor, that specializes in patients with temporary or chronic mental health issues.  They provide the best treatment options and care with compassion and patience.  A psychiatrist may prescribe medication (unlike a psychologist) when counseling and therapy have been ineffective or as a temporary measure until the patient is stable.  Psychiatry deals with mental disorders that originate in the brain, but they do not treat organic disorders like stroke, tumors, or epilepsy.  Sometimes behavioral issues appear that have an organic origin and a psychiatrist will be able to diagnose the difference.
 
In psychiatry the treatment options can vary depending on the success of the psychotherapy and medications.  It can also depend on the amount of social and emotional support received from friends and family members.  With progress, the medication can be reduced and therapy sessions adjusted.  If relapse occurs, it may be necessary to move to new treatment options or to resume some of the therapy sessions.
 
In addition to basic psychology, the psychiatrist must understand the medications available, as well as side effects and reliance on those drugs.  Many conditions can be treated without medication interventions.
 
Some mental illnesses or conditions are mild or temporary; some are severe and chronic.  Depression is one of those conditions that may run the gamut of severity.  Finding the cause of an illness can be critical to therapy.  For example, mild depression many be the result of a recent tragic event, like the death of a spouse and can be handled with appropriate psychological techniques.  Anxiety frequently involves a phobia (fear) in certain situations and can greatly affect a person's ability to act, such as a fear of flying can affect that person's career.  This is generally handled through psychological counseling and occasionally with medication depending on the degree of fear and the cause.
 
More severe cases are those people who suffer from hallucinations, delusions, and schizophrenia.  Through medications and treatment options many of these patients are able to function in normal situations.  Much of the result depends on accurate diagnosis and therapy to allow the individual to cope with the disorder.
 
Other disorders treated by psychiatrists are:

• Bipolar
• Trauma related conditions
• Eating disorders
• Obsessive-compulsive
• Sleep disorder
• Substance abuse
• Other personality disorders

 
It may take more than a single visit to diagnose the condition or disorder.  After that time, a plan of treatment is initiated.
 
Mental health issues have a wide range of causes and severity.  It is not always necessary to see a psychiatrist.  Sometimes the issues can be resolved through group discussion and therapy or other counseling.
 
Basically, a psychiatrist will assess mental and physical symptoms and help develop a plan for the treatment and recovery.  They can:

• Provide urgent care for sudden onset
• Help manage long-term illnesses
• Advise on lifestyle
• Work with you individually, as a group, or with others
• Provide second opinions
• Refer to other health care providers
• Admit someone to in-patient care

 

Transference is the shift of emotional involvement from one entity (person) to another.  This is usually focused on one important person in the patient's life to another.  Commonly it happens when the patient expresses feelings toward the therapist instead of to someone else (like a parent, significant other, etc.).  Although it is primarily the shift of emotions from one person to another, it could also involve an inanimate object. 
 
An example might be a person whose parent was critical of the patient's actions as a child or even as an adult.  If the therapist makes some remark that the patient interprets as judgmental, the patient becomes angry at the therapist, applying the emotions the patient would like to express to the parent.
 
In theory this can happen in everyday activities.  For instance, the formation of an unlikely friendship based on a perception of the other party to a close family member.  Like a person who treats a boss like a parent because of a physical or, more likely, emotional response. 
 
In therapeutic situations, transference can occur both positively and negatively.  Positive would be when a patient assumes the therapist has a specific characteristic, like wisdom.  Under normal circumstances, this will work to the therapist's benefit in being able to influence a change in behavior.  Negative is if the patient becomes angry with or suspicious of the therapist. 
 
Sexual transference occurs when the patient applies a romantic fantasy to the relationship between the therapist and the patient.  This can expand into sexual fantasies, which can become more intense and problematic.
 
When a therapist recognizes transference, he or she will use approved methods to point out the transference to the patient.  This includes the terminology (words used to describe the transference), relationship between the therapist and the client, and level of trust.  The therapist may consider this an opportunity to discuss the dynamics of a relationship.  However, if the transference begins to indicate a threat, either through anger or sexual interest, the therapist will carefully but completely manage the situation.
 
There are names for the more common types of transference.

• Paternal – When the client looks to another person as a father figure either idealized or as a position of power or protection.
• Maternal – When the patient treats another person as a mother figure for nurture and comfort.
• Sibling – In the absence of a parental relationship, this comes forward as a team-based relationship.
• Non-familial – This is when the client views a profession in an idealized manner.  Examples include a surgeon that never makes a mistake, a business owner who would never embezzle, or a pastor who would never sin.
• Sexualized – As mentioned previously, this is when a patient forms an unwarranted attraction to the therapist that can become detrimental to the therapist-patient relationship and the progress of the client.

 
Transference is when an individual redirects strong emotion from one person to another.  This is generally an unconscious process and often stems from childhood relationships or activities.

Experienced psychiatrists and counselors can recognize transference if it happens between patient and therapist and reduce or help reverse its effect on your therapeutic relationship with them.