“We are in this process together. Whatever happens, we are not giving up on you.”-Vladimir Maletic, MD

During this thought-provoking and interactive session, expert panelists shared 4 interesting psychiatric client cases and worked together with audience members to assess the patients and recommend the best treatment approaches. An incredible discussion ensued.

One of the first themes to emerge was the importance of connecting with the patient. The audience was reminded that patients seeking treatment are hurting and, as a result, may often put a guard up. Patients may hesitate to share necessary information about their medical history or past traumas in these circumstances. Providers must break through any walls to get a complete and accurate understanding of their patients.

Some successful strategies to overcome patient barriers shared by the audience included showing compassion, portraying hope, using humor to break tension and promote approachability, and even offering some limited self-exposure. Several participants spoke about the importance of shared decision-making and motivational interviewing. “Shared-decision making is something that we are, not something that we do,” Dr Chepke said. Understanding patients’ motivations for seeking treatment and their expectations of the outcomes provides valuable insight to help determine the best treatment approach. Open-ended questions can be a useful tool to understand patients thoroughly. When a patient is comfortable with their provider, both can work together to achieve the best outcomes. In the words of Dr Jain, “We [people] are medicine.”

The second and equally important theme to surface during this discussion was the vast amount of factors to consider in choosing the best treatment approach for a patient. Dr Maletic said, “There is no more biologically diverse condition than MDD.” Within the first patient case, it was clear that there is rarely just one correct answer, and certainly not an obvious one in many cases. A strong connection between patient and provider makes it easier to collect a full family and medical history—including any current or past medications, side effects, or adverse events. Furthermore, a provider should gather patient preferences, life circumstances, and patient lifestyle details that may help guide treatment decisions.

Even with all of this information collected from the patient, several questions will remain. Should pharmacotherapeutics, psychotherapy, or both be suggested for your patient? How should they be balanced? Some patients are vehemently opposed to pharmacotherapeutics; would holistic suggestions such as nutritional changes or meditation benefit your patient? Should hormone levels be assessed? Should referrals to additional providers, such as obstetrics and gynecology (OB-GYN), be considered? What side effects would be tolerable to your patient? Which side effects are deal-breakers? Which classes of medications, if any, have worked in the past? Which ones have not? What does this suggest about potential agents to try next?

One core tenet was evident throughout this activity: Psychiatry is an art. There are seemingly infinite factors to manage when treating patients. Fortunately, this challenge is met with deeply passionate and dedicated providers who will endlessly pursue the best treatment path for each patient.

Reference:
Jain R, Chepke C, Maletic V. Solving clinical challenges: focus on major depression. Presented at: Psych Congress; September 6-10, 2023; Nashville, TN.