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PSYCHIATRY Psychiatrists and neurologists collaborate to affect patient outcomes
A meeting of the minds
When we think of legendary stage and screen actor Kirk Douglas,we think of a tough guy. He was Spartacus and Doc Holiday in “Gunfight at the O.K.Corral.” The characters he portrayed were always looking for a fight. In real life,however, Douglas almost gave up the fight.
BY MAUREEN KOVACIK
In 1996, at the age of 79, Douglas suffered a debilitating stroke that severely impaired his speech. In his book“My Stroke of Luck,” he describes feelings of hopelessness. He couldn’t speak, he couldn’t act. The cleft-chinned movie icon whose career spanned 40-plus years and more than 90 films had lost his ability to continue his life’s work.
What did he have to live for? Through his steely blue eyes — the ones that had caused thousands of young girls to swoon — he saw no future worth having.
Severe depression and despair led the three-time Academy Award nominee to put a gun in his mouth, but suicide was not his fate. He bumped his tooth, started to laugh at his failed attempt, and decided he, in fact, did want to live.
DEPRESSION CAN HINDER RECOVERY
Depression after an illness such as a stroke or chronic medical condition like heart disease, diabetes or kidney disease is not uncommon. In fact, 10 to 27 percent of stroke patients suffer from major depression; and the number grows to 40 to 65 percent of patients who suffered a heart attack.
Comorbid psychiatric disorders — psychiatric disorders that exist simultaneously and usually independently of another medical condition — such as depression, anxiety, psychotic symptoms or behavioral and cognitive changes are frequently seen in patients in a hospital setting.
“It is important to recognize mood disorders, such as depression in a timely manner because untreated clinical depression hurts the recovery process,” said Dr. Ranjit Chacko, vice chair of psychiatry at The Methodist Hospital.
Neurologists and psychiatrists collaborate to affect patient outcomes after potentially catastrophic illnesses
“Methodist psychiatrists collaborate with neurologists, neuropsychologists and rehabilitation physicians and therapists to provide the best possible outcome after a potentially catastrophic illness.”
In addition to this team approach, patients benefit from treatment at Methodist because the hospital has the only inpatient psychiatric unit in the Texas Medical Center.
The hospital’s unique psychiatric service provides psychiatric acute care to the medically ill inpatient. Patients are evaluated in neurology, medical or intensive care units, such as the stroke unit, or transferred to the psychiatric unit, for management of safety and behavior, as required.
Symptoms of depression may be more difficult to identify in the medically ill patient but generally are similar to patients who develop the disorder independently. They include sadness, loss of interest, unexplained weight loss, insomnia, fatigue, and negative or suicidal thoughts.
Depression may be directly caused by damage to critical areas of the brain, which deplete neurotransmitters — chemicals within the brain that enable nerve cells to communicate with each other. When these neurotransmitters are damaged, mood symptoms may occur.
A stroke, for example, can damage an area of the brain that may alter the patient’s mood, cognition and behavior. Patients with Parkinson’s disease or multiple sclerosis are other examples of neurological disease where mood disorders are frequently seen and require careful evaluation and treatment.
Under these circumstances, depression is more difficult to treat. The physician must be skilled in the selection of antidepressants because certain medications may compromise or interact with those given for the medical condition.
“Also, medications that are used to treat the physical problem may affect a patient’s mood,” said Methodist psychiatrist Dr. Priscilla Ray. “Known as secondary depression, doctors have to rule out such side effects before they provide treatment.”
THE ROOTS OF NEUROPSYCHIATRY
Ancient psychiatry began around the fifth century B.C. with the belief that mental disorders came from supernatural sources. By the Middle Ages, psychiatric “hospitals” were established, but the concept of treating mental disorders medically didn’t really take hold until the 20th century.
“There is a considerable overlap between the fields of neurology and psychiatry,” Ray said. “Sigmund Freud was originally a neurologist and was among the first to realize that not all disorders stem from a neurological source.” Modern psychiatry now involves an interdisciplinary approach involving biological and social science. Neurology is an integral part of this approach.
“Recent research indicates that patients with recurrent (occurring time after time) depression, who are not adequately treated to remission, may be more likely to develop dementia later in life,” said Chacko, who is also professor of psychiatry and behavioral sciences at Baylor College of Medicine.
“Effective treatment to remission of severe mood disorders could even help prevent future development of dementia. Here at Methodist, we have some of the best minds and best technology to help improve the outcomes of these patients,” he said.
As for Kirk Douglas, he battled his way out of depression with the help of his physicians, the proper medication, speech therapy, friends and family. He even returned to the big screen in the 1999 movie “Diamonds,” where he portrayed an ex-prizefighter who, with heart and determination, fought back after a stroke.
