What do we mean by the term “PSYCHOLOGICAL MEDICINES”?
The field of psychological medicines aims at improving medical care by focusing on psychological domains of medical evaluation and treatment.
Approximately 25-30% of patients with general medical conditions have coexisting mental health problem such as anxiety, depressive, somatoform, or substance use disorders (Ormel et al., 1994).
Variety of factors account for the co-existence of general medical conditions and mental health disorders.
First, a general medical condition can occasionally be a cause of the mental health problem (e.g., hypothyroidism as a cause of mood disorders).
Second, general medical conditions such as diabetes, cardiovascular diseases, cancer, neurological disorders, and many others have potential to increase the risk of major depressive disorder and other mental health disorders.
Coincidence is a third main factor. General medical conditions such as hypertension may co-exist with depression in the same patient because both are quite prevalent.
Role of psychological medicine also comes in when some types of medical symptoms are not explained by disease. Research evidence exist to support that although somatic symptoms are responsible for more than half of all the consultations to doctors, at least one of these symptoms remain medically unexplained and this is called “somatization”. Most patients suffering from somatization preferentially present with somatic symptoms rather than mental health related symptoms. Moreover, there are the common syndromes that are not completely understood such as irritable bowel syndrome (IBS), fibromyalgia and chronic fatigue syndrome, for which the relative contributions of body and mind are not yet fully explained.
It is not always necessary to treat above mentioned problems in psychiatry departments. There are potential alternatives of it. One possibility is to develop capacity of general practitioners (GPs) to identify, diagnose and offer initial treatment for common mental disorders such as anxiety and depression. GPs can be trained both in brief culturally adapted psychosocial interventions as well as in prescribing psychotropic medications. Nurses with specialised training can also work with GPs or mental health professionals to deliver psychosocial interventions as well as to manage medications. Collaborative can be another possible approach. The GP’s management is augmented by visits to a mental health professional. Stepped care is another model, in which psychiatric referral occurs only for patients who do not respond to the GP’s initial treatment.
Psychological medicine plays a vital role to improve outcomes. The benefits of treating psychological distress and common medical symptoms effectively in patients with general medical conditions not only leads to improved social and work functioning and health related quality of life, but also leads to greater satisfaction on the part of doctor and patient and reduced use of healthcare services.
Ormel J, Von Korff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health care. JAMA. 1994;272:1741–1748