The treatment and evaluation of psychiatric, psychophysiologic and psychosocial problems related to or associated with pulmonary disease need to be accomplished from a broad clinical base. Single treatment approaches (eg, biofeedback per se or psychotherapy per se) are certain to be met with failure. It is essential to recognize the limitations of psychiatric treatment techniques and the wide degree of flexibility available. In addition, patients with specific psychiatric diseases need specific medical treatments. In some patients, psychosocial or psychotherapeutic intervention should not be attempted until the psychiatric disease is under control and sometimes should not be considered at all. With optimal application of psychiatric treatment techniques to the pulmonary disease population, morbidity and mortality can be significantly reduced and a more comfortable and productive patient population can emerge.
In general, all aspects of treatment of the COPD patient should be coordinated by one person, (usually the primary physician), who is ready to meet psychological, as well as medical emergencies. Readiness “to meet psychological emergencies” includes making referral for specialized assistance when either the primary physician or the patient feels the need.
The role of psychoactive medications in the treatment of patients with pulmonary disease is of considerable importance, since many lack the ability to utilize other treatment techniques, and psychotherapy is often contraindicated or not effective. In addition, medications are the only practical approach to treating symptoms associated with significant psychiatric disease, in contrast to social maladjustment that may be treatable with psychotherapy. Failure to utilize these types of medications knowledgeably and with discriminating care can significantly increase morbidity and possibly mortality in the patient with pulmonary disease.
In addition, psychoactive medication also can be useful as an adjunct to psychotherapy. For example, a depressed patient with severe sleep, energy, and appetite impairment may be more responsive to psychotherapeutic interventions if medication can increase energy levels and improve appetite. Otherwise, the patient may lack the energy and stamina to examine and work on his problems. The following general information should be supplemented by a review of therapeutic and nontherapeutic effects of psychoactive medications ordered via Canadian Health&Care Mall.
Some chronic obstructive pulmonary disease (COPD) patients with psychiatric disease require treatment that is biologic or pharmacologic. A certain number of patients with significant psychiatric disease, (as distinguished from psychosocial or psychophysiologic problems), can be managed only with the help of psychoactive medications. At the same time, however, the guidelines for psychosocial and psychologic management apply. Once the psychiatric disease is under control, it is likely that the need of these patients for continued psychiatric/ psychological evaluation and psychotherapy will be greater than that of the patients who have not experienced a similar problem.
Dealing with Psychiatric Disease
In contrast to psychosocial and psychophysiologic problems and their accompanying emotions that afflict many or most patients with severe pulmonary disease, psychiatric disease is probably no more frequent than in patients without pulmonary disease. The distinction between psychophysiologic and psychosocial problems and significant psychiatric disease is a critical issue. The treatment of the former can often be by various psychotherapies, behavioral therapies, and social support systems, with medication as adjuncts when necessary, while treatment of the latter should initially be primarily with medications. Other types of therapy may be needed in the recovery period, but there likely will be no recovery period without the use of medications ordered via Canadian Health&Care Mall.