Psychiatric Services

Psychiatric assessment:

A psychiatric assessment is done by a psychiatrist. Our psychiatrist will perform a new patient evaluation, screening for the common psychiatric conditions such as depression, anxiety, bipolar disorder, eating disorders, and more. This evaluation may be broad or more focused, catered to each individual patient. Medications may or may not be started, depending on the recommendation of the psychiatrist and the preference of the patient. We also conduct bariatric surgery assessments, employment assessments, and school related assessments.

Medication management:

This is predominantly the role of a psychiatrist. After a patient is established in our clinic, it is then determined with the patient and the psychiatrist whether or not medications will be used to help treat the mental health condition. If medications are used, then regular follow up appointments are scheduled, lasting about 10-30 minutes, depending on each patient. During these appointments, we discuss side effects, dosage changes, or medication changes. Brief supportive therapy may also be done during these encounters.

Adolescent and adult treatments:

Our clinic sees child, adolescent, and adult patients. We will work with each patient and their family, as appropriate, to achieve relief for the patient from their mental health condition. The following list is a sample of the disorders and conditions we treat, but we are not limited to this list:

  • Major depressive disorder

Curing major depressive disorder (MDD) is a complex and multifaceted process that can vary significantly from person to person. There isn't a one-size-fits-all "cure" for MDD, but there are many effective treatments available that can help manage symptoms, lead to remission, and improve quality of life. These treatments often include a combination of medication, psychotherapy, lifestyle changes, and sometimes more innovative approaches for treatment-resistant depression. Here's an overview of the main treatment strategies:

  1. Medications: Antidepressants are commonly prescribed to help manage the symptoms of depression. There are several classes of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Finding the right medication or combination of medications can take time and often requires careful monitoring and adjustments by a healthcare provider.

  2. Psychotherapy: Also known as talk therapy, psychotherapy can be highly effective in treating depression. Cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and psychodynamic therapy are among the most researched and utilized forms. These therapies can help individuals understand and work through the underlying issues contributing to their depression, develop coping strategies, and improve their thought patterns and behaviors.

  3. Lifestyle Changes: Regular physical activity, a nutritious diet, adequate sleep, and stress reduction techniques can have a significant impact on managing depression symptoms. Lifestyle interventions can complement other treatment methods and contribute to overall well-being and mental health.

  4. Electroconvulsive Therapy (ECT) and Other Brain Stimulation Therapies: For severe depression or when other treatments have failed, ECT and newer brain stimulation therapies like repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS) can be options. These treatments can be effective for people with treatment-resistant depression.

  5. Support Groups and Peer Support: Connecting with others who are going through similar experiences can provide emotional support, understanding, and encouragement.

  6. Complementary and Alternative Medicine (CAM): Some people find relief from symptoms with approaches like meditation, acupuncture, or certain supplements. However, it's important to discuss these with a healthcare provider before starting, as they can interact with other treatments.

The effectiveness of these treatments varies among individuals, and it may take some time to find the most effective combination. Continuous monitoring and adjustment by healthcare professionals are crucial in managing the condition effectively. If you or someone you know is struggling with depression, it's important to seek help from a healthcare professional who can tailor a treatment plan to individual needs.

  • Adjustment disorders

Adjustment disorder is considered a type of mental health condition that occurs in response to a significant stressor or life-changing event. It's characterized by emotional and behavioral symptoms that develop within three months of experiencing the identified stressor. These symptoms can include feelings of sadness, hopelessness, lack of enjoyment in everyday activities, frequent crying, anxiety, difficulty sleeping, concentration issues, and feeling overwhelmed. Unlike normal stress responses, the reactions in adjustment disorder are more severe and can significantly impair social, occupational, or other important areas of functioning.

The stressor can be a single event (e.g., losing a job, divorce, major illness) or more complex and ongoing problems (e.g., ongoing marital issues, chronic health problems, living in a crime-ridden neighborhood). The severity of the disorder can vary from mild to severe based on the level of impairment and the distress it causes.

Adjustment disorders are treatable and often resolved with the appropriate intervention, which may include psychotherapy (such as cognitive-behavioral therapy or support groups), medications to address symptoms like anxiety or depression, and strategies to develop coping mechanisms and resilience. The prognosis is generally good, especially when the stressor can be removed or when the individual learns healthier coping strategies.

It's important to differentiate adjustment disorder from other mental health conditions, as the distinction can influence the treatment approach. For example, while adjustment disorder symptoms are specifically linked to a stressor and usually resolve within six months after the stressor or its consequences have ended, conditions like major depressive disorder or generalized anxiety disorder are not limited by specific stressors or time frames.

  • Bipolar disorder

Bipolar disorder, also known as bipolar affective disorder, is characterized by significant mood swings that include emotional highs (manic or hypomanic episodes) and lows (depressive episodes). These mood swings can affect behavior, judgment, and the ability to think clearly. People with bipolar disorder may experience the following behaviors associated with each phase of the disorder:

During Manic Episodes

  • Increased Activity or Energy: Engaging in numerous activities at once, increased restlessness, and an exaggerated sense of well-being and self-confidence.
  • Euphoria: Feeling unusually “high,” overly happy, or outgoing.
  • Decreased Need for Sleep: Feeling rested after very little sleep.
  • Talking a Lot: Talking more than usual, feeling pressure to keep talking.
  • Racing Thoughts: Experiencing thoughts that race through the mind, jumping quickly from one idea to another.
  • Impulsivity and Poor Judgment: Making poor decisions, like going on buying sprees, taking sexual risks, or making foolish investments.
  • Irritability: Easily irritated or agitated with friends, family, or work situations.

During Hypomanic Episodes

Hypomanic episodes involve similar behaviors to manic episodes but are less severe and do not cause the major problems that mania often does (e.g., serious issues at work, significant relationship stress, need for hospitalization).

During Depressive Episodes

  • Sadness or Hopelessness: Feeling down, sad, empty, or hopeless for most of the day, nearly every day.
  • Withdrawal from Activities: Loss of interest in activities once enjoyed.
  • Changes in Appetite or Weight: Significant weight loss when not dieting, weight gain, or decrease or increase in appetite.
  • Sleep Problems: Insomnia or sleeping too much.
  • Fatigue or Loss of Energy: Feeling extremely tired and having little energy.
  • Feelings of Worthlessness or Guilt: Excessively criticizing oneself for perceived faults and mistakes.
  • Difficulty Concentrating: Trouble focusing, making decisions, or remembering things.
  • Thoughts of Death or Suicide: Frequent thoughts of death, suicidal ideation, or suicide attempts.

It's important to note that the severity and frequency of these episodes can vary widely among individuals with bipolar disorder. Some may experience distinct episodes of mania and depression with periods of normal mood in between, while others may have rapid cycling bipolar disorder, with four or more episodes within a year. Treatment for bipolar disorder typically involves a combination of medication (such as mood stabilizers, antipsychotics, and antidepressants) and psychotherapy to manage symptoms and help the individual lead a stable, productive life.

  • Schizophrenia and related disorders

chizophrenia is a complex, chronic mental health disorder characterized by a range of symptoms, which can be divided into three main categories: positive symptoms, negative symptoms, and cognitive symptoms. It is part of a broader group of disorders known as psychotic disorders, which involve distorted perceptions of reality. The causes of schizophrenia are believed to be multifactorial, involving a combination of genetic, brain chemistry, and environmental factors

Positive Symptoms

Positive symptoms refer to the presence of psychotic behaviors not seen in healthy people. People with positive symptoms may "lose touch" with some aspects of reality. Symptoms include:

  • Hallucinations: seeing or hearing things that don't exist.
  • Delusions: false beliefs not based on reality.
  • Thought disorders: unusual or dysfunctional ways of thinking.
  • Movement disorders: agitated body movements.

Negative Symptoms

Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. They include:

  • "Flat affect" (reduced expression of emotions via facial expression or voice tone).
  • Reduced feelings of pleasure in everyday life.
  • Difficulty starting and sustaining activities.
  • Reduced speaking.

Cognitive Symptoms

Cognitive symptoms pertain to changes in memory or other aspects of thinking. They include:

  • Poor "executive functioning" (the ability to understand information and use it to make decisions).
  • Trouble focusing or paying attention.
  • Problems with "working memory" (the ability to use information immediately after learning it).
Related Disorders

Schizophrenia is part of a spectrum of psychiatric conditions that may have overlapping symptoms, including schizoaffective disorder and the broader category of schizophrenia spectrum and other psychotic disorders. Schizoaffective disorder, for example, features symptoms of both schizophrenia and mood disorders (such as depression or bipolar disorder).

Diagnosis and Treatment

Diagnosing schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to substance abuse, medication, or a medical condition. Treatment typically includes antipsychotic medications and psychotherapy, such as cognitive behavioral therapy (CBT). Supportive therapies, life skills training, and rehabilitation play roles in managing the condition, aiming to reduce symptoms and improve quality of life.

Understanding schizophrenia and related disorders requires a multidisciplinary approach, involving psychology, psychiatry, neuroscience, and social sciences, to address the complex interplay of factors contributing to these conditions.

  • Personality disorder

    Personality disorders are a group of mental health conditions characterized by enduring patterns of thinking, feeling, and behaving that significantly deviate from what is considered normal within a particular culture. These patterns are unhealthy and inflexible, leading to serious problems in relationships, work, and social activities.

    Here are some key points about personality disorders:

    1. Complex Traits: People have unique personalities formed by a blend of genetic factors and environmental influences. Personality traits impact how individuals perceive the world, relate to others, and view themselves.

    2. Adaptive vs. Maladaptive Traits: Ideally, personality traits allow individuals to adapt flexibly to their changing environment, leading to healthy relationships and effective coping strategies. However, when traits are less adaptive, they result in inflexibility and unhealthy coping mechanisms.

    3. Lifelong Patterns: Personality disorders manifest as lifelong patterns of seeing oneself and reacting to others. These patterns cause significant distress and functional impairment. Individuals with personality disorders often struggle with understanding emotions, tolerating distress, and acting impulsively.

    4. Clusters of Disorders: Personality disorders are categorized into three clusters based on shared features and symptoms:

      • Cluster A: These disorders involve consistently dysfunctional thinking and behavior, often reflecting suspicion or lack of interest in others. Examples include paranoid personality disorder (marked by distrust and suspicion) and schizoid personality disorder (characterized by emotional detachment and disinterest in social interactions).

      • Cluster B: These disorders involve intense, unstable emotions and impulsive behaviors. Examples include borderline personality disorder (marked by unstable relationships, self-image, and emotions) and narcissistic personality disorder (excessive self-importance and lack of empathy).

      • Cluster C: These disorders are characterized by anxiety and fearfulness. Examples include avoidant personality disorder (fear of rejection and social situations) and obsessive-compulsive personality disorder (preoccupation with orderliness and control).

    5. Causes: Personality disorders are believed to result from a combination of genetic and environmental factors. Early life experiences, family dynamics, and individual temperament contribute to their development.

    6. Impact: Personality disorders affect various aspects of life, including family relationships, social interactions, work performance, and overall quality of life.

    Remember that seeking professional help is essential for accurate diagnosis and effective management of personality disorders. If you or someone you know is experiencing symptoms, consider reaching out and booking an appointment with us today.

  • Autism spectrum disorder

    Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that affects how individuals perceive the world, interact with others, and communicate. Here are some key points about ASD:

    1. Variability: ASD covers a broad spectrum, and its manifestations can vary significantly from person to person. Some individuals have high support needs, experience developmental delays, and may be non-speaking.

    2. Social Challenges: People with ASD often struggle with social interactions. They may find it challenging to understand social cues, express emotions, and engage in reciprocal communication.

    3. Repetitive Behaviors: Repetitive movements, interests, and routines are common in ASD. These behaviors provide comfort and predictability but can interfere with daily life.

    4. Sensory Sensitivities: Many individuals with ASD have heightened or diminished sensitivity to sensory stimuli (such as lights, sounds, textures). These sensitivities can impact their experiences and reactions.

    5. Communication Differences: While some individuals with ASD are non-verbal, others may have advanced language skills. However, they might struggle with pragmatic language (using language appropriately in social contexts).

    6. Early Signs: Signs of ASD often appear in early childhood. Parents may notice delayed speech, lack of eye contact, repetitive movements, and difficulty with social play.

    7. Causes: The exact causes of ASD are not fully understood, but a combination of genetic, environmental, and neurological factors likely contribute.

    8. Interventions: Early intervention, behavioral therapies, speech therapy, and educational support can help individuals with ASD develop essential skills and improve their quality of life.

  • Posttraumatic stress disorder

    Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. Here are some key points about PTSD:

    1. Symptoms: PTSD symptoms can start within a month of the trauma or even years later. They fall into four categories:

      • Intrusive Memories: Recurrent distressing memories, flashbacks, and nightmares related to the traumatic event.
      • Avoidance: Trying to avoid thoughts, conversations, or places associated with the trauma.
      • Negative Changes in Thinking and Mood: Negative thoughts about oneself, hopelessness, memory problems, and emotional detachment.
      • Changes in Physical and Emotional Reactions: Hypervigilance, irritability, trouble sleeping, and self-destructive behavior.
    2. Causes: PTSD can result from various traumatic events, such as accidents, sexual assault, war, or natural disasters. Risk factors include a family history of anxiety or depression and previous exposure to trauma.

    3. Impact: PTSD affects daily functioning, relationships, and mental well-being. It can lead to depression, substance abuse, and suicidal tendencies.

    4. Treatment: Effective treatment is crucial. Psychotherapy (such as cognitive-behavioral therapy) and medication (antidepressants or anti-anxiety drugs) can help manage symptoms.

  • Eating disorders

    Eating disorders are serious health conditions that affect both your physical and mental well-being. These conditions involve problems related to how you think about food, eating, weight, and body shape, as well as your eating behaviors. Here are some key points:

    1. Types of Eating Disorders:

      • Anorexia Nervosa: Individuals with anorexia have an unhealthy low body weight, intense fear of gaining weight, and a distorted view of their weight and shape. They often engage in extreme efforts to control weight, such as severely limiting calories or using methods like excessive exercise, laxatives, or vomiting.
      • Bulimia Nervosa: Bulimia involves episodes of binge eating (consuming large amounts of food in a short time) followed by purging behaviors (such as vomiting or using laxatives). People with bulimia may also restrict their eating at times.
      • Binge-Eating Disorder: This disorder involves recurrent episodes of overeating without purging. People feel a loss of control during binges and experience guilt or shame afterward.
      • Other Types: Additional eating disorders include pica (eating non-nutritious substances), rumination disorder, and avoidant/restrictive food intake disorder (ARFID).
    2. Impact on Health and Emotions:

      • Eating disorders can harm the heart, digestive system, bones, teeth, and mouth.
      • They’re associated with depression, anxiety, self-harm, and suicidal thoughts.
      • These conditions can seriously affect daily functioning and quality of life.
    3. Causes and Treatment:

      • The exact causes are not fully understood, but genetics, biology, and environmental factors play a role.
      • Treatment involves psychotherapy (such as cognitive-behavioral therapy), nutritional counseling, and sometimes medication.
      • With proper care, individuals can develop healthier eating habits and improve their overall well-being.

        Remember that seeking professional help is crucial for effective management and recovery from eating disorders

  • Generalized anxiety disorder

    Generalized anxiety disorder (GAD) is a mental health condition characterized by excessive, ongoing anxiety and worry that are difficult to control. Here are some key points about GAD:

    1. Symptoms:

      • Uncontrollable Worry: Individuals with GAD experience persistent and excessive worry about everyday life events, even when there is no apparent reason.
      • Physical Symptoms: These may include restlessness, irritability, trouble sleeping, sweating, nausea, and heart palpitations.
      • Difficulty Concentrating: GAD can impair focus and decision-making abilities.
      • Startling Easily: People with GAD may be easily startled or feel on edge.
    2. Causes:

      • The exact cause of GAD is unknown, but it may result from a combination of genetic predisposition, abnormal brain functioning, and exposure to traumatic or stressful events.
      • Chronic medical illnesses or other mental health disorders may increase the risk.
    3. Impact on Health:

      • GAD can impair daily functioning, affect relationships, and lead to physical health issues.
      • It may cause or worsen conditions like insomnia, depression, and substance abuse.
    4. Treatment:

      • Psychotherapy: Cognitive-behavioral therapy (CBT) helps individuals manage anxious thoughts and behaviors.
      • Medication: Antidepressants and anti-anxiety drugs may be prescribed.
      • Healthy Lifestyle: Regular exercise, stress reduction techniques, and maintaining social connections are essential.

    Remember that seeking professional help is crucial for managing GAD effectively and improving overall well-beingSocial anxiety disorder

  • Panic attacks

    Panic attacks are sudden episodes of intense fear and anxiety that trigger severe physical reactions, even when there is no real danger or apparent cause. Here are some key points:

    1. Symptoms:

      • Uncontrollable Worry: People experience persistent and excessive worry about everyday life events.
      • Physical Symptoms: These may include restlessness, irritability, trouble sleeping, sweating, nausea, and heart palpitations.
      • Difficulty Concentrating: Panic attacks can impair focus and decision-making abilities.
      • Startling Easily: Individuals may feel on edge or easily startled.
    2. Causes:

      • The exact reasons for panic attacks are unknown, but factors like genetics, stress, sensitive temperament, changes in brain functioning, depression, and certain medical conditions play a role.
      • Risk factors include a family history of anxiety or panic disorders, stressful life events, and substance use.
    3. Impact on Health:

      • Panic attacks can impair daily functioning, affect relationships, and lead to physical health issues.
      • If untreated, they may lead to complications such as specific phobias, social avoidance, depression, and suicidal thoughts.
    4. Treatment:

      • Psychotherapy: Cognitive-behavioral therapy (CBT) helps manage anxious thoughts and behaviors.
      • Medication: Antidepressants and anti-anxiety drugs may be prescribed.
      • Lifestyle Changes: Regular physical activity, avoiding triggers (caffeine, alcohol), and getting enough sleep are essential.

    Remember to seek professional help if you experience panic attacks or know someone who does.

  • Attention deficit hyperactivity disorder (ADHD)

    Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects both children and adults. Here are some key points:

    1. Symptoms:

      • Inattention: Individuals with ADHD struggle to focus, follow instructions, and complete tasks. They may be forgetful and easily distracted.
      • Hyperactivity: Some people exhibit excessive restlessness, fidgeting, and an inability to sit still.
      • Impulsivity: Impulsive behaviors include interrupting others, acting without thinking, and difficulty waiting their turn.
    2. Types:

      • Predominantly Inattentive Presentation: Characterized by inattention without significant hyperactivity or impulsivity.
      • Predominantly Hyperactive-Impulsive Presentation: Mainly hyperactivity and impulsivity without marked inattention.
      • Combined Presentation: A mix of all three symptoms.
    3. Causes:

      • Genetics: Family history plays a role.
      • Brain Structure and Function: Abnormalities in brain regions related to attention and impulse control.
      • Environmental Factors: Exposure to toxins, premature birth, and maternal smoking during pregnancy.
    4. Impact:

      • ADHD affects academic performance, relationships, and self-esteem.
      • Adults may struggle with organization, time management, and maintaining stable employment.
    5. Diagnosis and Treatment:

      • Diagnosis involves clinical assessment, symptom evaluation, and ruling out other conditions.
      • Treatment includes:
        • Behavioral Therapy: Helps develop coping strategies and improve behavior.
        • Medication: Stimulants (like methylphenidate) or non-stimulants (like atomoxetine) may be prescribed.

    Remember that early intervention and support are crucial for managing ADHD and improving overall functioning.

  • Substance use disorders (Addiction)

    Substance use disorder (SUD), commonly known as addiction, is a complex mental health condition characterized by the inability to control the use of substances (legal or illegal drugs, alcohol, or medications) despite harmful consequences. Here are some key points:

    1. Symptoms:

      • Compulsive Use: Individuals with SUD have an intense focus on using specific substances, leading to impaired functioning in daily life.
      • Harmful Consequences: Despite knowing the negative impact, people continue to misuse substances.
      • Severity: Symptoms can range from moderate to severe, with addiction being the most severe form of SUD.
    2. Causes and Impact:

      • Brain Changes: Addiction alters brain structure and function, leading to intense cravings, personality changes, and abnormal behaviors.
      • Risk Factors: Genetic predisposition, environmental factors, and exposure to substances contribute to SUD.
      • Health and Life Effects: SUD affects physical health, relationships, work, and overall well-being.
    3. Treatment:

      • Behavioral Therapies: Cognitive-behavioral therapy (CBT), motivational enhancement, and contingency management help individuals modify behavior and develop coping strategies.
      • Medication: Medications (such as methadone for opioid addiction) can assist in managing withdrawal symptoms and cravings.
      • Support Groups: Peer support and counseling play a crucial role in recovery.

    Remember that seeking professional help is essential for managing substance use disorders and achieving long-term recovery

  • Cranial Electric Stimulation Therapy

    Cranial electrotherapy stimulation (CES) is a form of neurostimulation that delivers a small, pulsed, alternating current via electrodes on the head. It is used with the intention of treating various conditions such as anxiety, depression, and insomnia. Here are some key points about CES:

    • How It Works: CES involves applying a low-intensity electrical current to specific spots on the head, such as the earlobes or temples. The current is minuscule (ranging from 50 to 500 millionths of an ampere) and is different from more intense treatments like electroconvulsive therapy (ECT) used for severe depression and mania.
    • Alpha-Stim Device: The Alpha-Stim Anxiety Insomnia and Depression (AID) device is commonly used for CES. It’s a mobile, phone-sized device with electrodes that clip onto the earlobes. The FDA has approved it for treating anxiety, depression, and insomnia. Preliminary evidence also suggests its effectiveness for acute, chronic, or post-traumatic pain.
    • Mechanism: CES works with the nervous system to normalize cell signals. Neurotransmitters like serotonin and dopamine play a crucial role in mood regulation. When out of balance, mood disorders can develop. CES aims to restore balance by modulating these neurotransmitters.
    • Effectiveness: Research indicates that Alpha-Stim is effective for anxiety, although it may not be as potent as cognitive-behavioral therapy. Further studies are needed to explore its impact fully.

    Remember that individual responses to CES may vary, and some people experience immediate relief, while others may need multiple sessions