“Psychiatrists have to be very patient and understanding” - Dr Qurat-ul-Ain Khan

CAREER COUNSELLING

With a training background in psychiatry and human neurology, Qurat-ul-Ain Khan is an assistant professor at the Department of Psychiatry, Aga Khan University Hospital. She is also a consultant psychiatrist.

Dr Qurat did her residency in General Psychiatry from Chicago Medical School, and then went on to do a fellowship in Behavioural Neurology and Neuropsychiatry from Mayo Clinic in Jacksonville.

She tells Us about the field of psychiatry.

Describe psychiatry for our readers. What does a psychiatrist do?

Psychiatry or psychiatric conditions are internationally understood as based on biopsychosocial model. These conditions have contributions from biology (neurotransmitters, chemicals in your brain which may affect your behaviour, and other domains of cognition), psychology (personality makeup, upbringing, coping mechanism), and sociology (surrounding, relationships, occupational environment).

Mostly, when somebody comes to us, we try to address each of these components. A psychiatrist may either prescribe medication, or send patients for psychological intervention, or both.

What’s the scope of psychiatry in Pakistan?

Right now, there are around 400 trained psychiatrists in the whole country. The psychiatrist-population ratio is 1:1,000,000 which, I think, is a huge gap.

How is a psychiatrist different from a psychologist?

Psychiatrist is a medical doctor who specialises in psychiatry and then completes his/her four-year residency to become a certified doctor. They can prescribe medicines to their patients. On the other hand, psychologists don’t graduate from a medical school; they have Masters and PhD degrees in psychology. They are not authorised to prescribe medicines.

What misconceptions do you hear from patients or people from other fields about psychiatry?

I’ve heard a lot of weird things. The first and foremost is the stigma attached to it. People don’t come to psychiatry clinics and even when they do take an appointment, they’d ask the nurse to not call out their names when it’s their turn for fear of being seen and labelled as “pagal”. It’s also a major challenge to treat them.

Second, people think psychiatric medicine is harmful. They are willing to take medication for diabetes and hypertension, but somehow there is this perception that psychiatric medicine is addictive and that they are just sleep-inducing. I have to explain to them that this is not the case.

Third, there are a lot of cultural manifestations. For instance, when people hear voices, they think they’re possessed and they would rather go to spiritual healers and molvis. Many a time people have paranoia: they don’t get along with other people and others would suggest marriage as a solution to the problem! Paranoid symptoms are mistaken for jaadu their saas (mother-in-law) or nand (sister-in-law) possibly have done.

Last but not the least, our propensity for recognising these symptoms as psychiatric illnesses is very high since we rationalise the symptoms using our own belief system.

What should students consider before deciding to specialize in psychiatry?

For a majority of students, psychiatry is similar to other medical professions; that is, they could get a particular test done to diagnose a particular condition. That’s not the way it works. There are no biomarkers, no diagnostic tests. It’s just by talking to the patient and trying to know that individual you treat him. One has to be very patient, receptive, and able to understand and connect to them on a personal level. 

It requires communication skills and empathy all the time to be able to manage and diagnose; knowledge of behavioural changes is a plus. If you have that temperament, then I think you are very suitable for this field.

Describe one thing you find fulfilling about working in the industry.

It’s very life changing. You know, chronic mental illnesses are very disabling; they cause a lot of functional impairment. People may or may not be able to work, be able to get married or maintain relationships. You can change all of that - the way they are a part of their families and societies. Some people are impaired for years. When they recover, it’s rewarding.

Common types (aka classes or categories) of psychiatric disorders

• Anxiety Disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30 percent of adults at some point in their lives. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, social anxiety disorder and separation anxiety disorder.
  
• Neurodevelopmental Disorders are a group of conditions with onset in the developmental period. The disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning. For example attention-deficit/hyperactivity disorder (ADHD), learning disorders, and autism spectrum disorder.
  
• Bipolar Disorders are brain disorders that cause changes in a person’s mood, energy and ability to function. It includes three different conditions - bipolar I, bipolar II and cyclothymic disorder - wherein people have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive. People with bipolar disorders generally have periods of normal mood as well.
  
• Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behaviour (including catatonia), and negative symptoms.
  
• Depressive Disorders are characterised by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown but probably involves heredity, changes in neurotransmitter levels, altered neuroendocrine function, and psychosocial factors. Examples include major depressive disorder and premenstrual dysphoric disorder (PMDD) and major depressive disorder.
  

Source: www.psychiatry.org