Detailed overview of psychiatric medications. Anti-depressant and anti-anxiety medications, bipolar medications, antipsychotic drugs.

Mental illnesses are among the most common conditions affecting health today: One in five American adults suffers a diagnosable mental illness in any six month period. According to the National Institute of Mental Health, though, some 90 percent of these people will improve or recover if they get treatment. Psychiatrists and other physicians treating mental illnesses have a wide variety of treatments available today to help them help their patients. Most often, psychiatrists will work with a new patient to construct a treatment plan that includes both psychotherapy and a psychiatric medication. These medications--combined with other treatments such as individual psychotherapy, group therapy, behavioral therapy or self-help groups--help millions each year to return to normal, productive lives in their communities, living at home with loved ones and continuing their work.

Mental Illnesses and Medications

Psychiatric researchers believe that people suffering from many mental illnesses have imbalances in the way their brain metabolizes certain chemicals, called neurotransmitters. Because neurotransmitters are the messengers the nerve cells use to communicate with one another, these imbalances may result in the emotional, physical and intellectual problems that mentally ill people suffer. New knowledge about how the brain functions has permitted psychiatric researchers to develop medications which can alter the way in which the brain produces, stores and releases these neurotransmitter chemicals, alleviating the symptoms of the illness.

Find out about specific psychiatric medications

Psychiatric Medications

Psychiatric medications are like any other medicine your doctor would prescribe. They are formulated to treat specific conditions, and they must be monitored by a physician, such as a psychiatrist, who is skilled in treating your illness. Like most medications, psychiatric prescriptions may take a few days or a few weeks to become fully effective.

All medicines have positive and negative effects. Antibiotics, which cure potentially serious bacterial infections, can cause nausea. Heart disease medication can cause low blood pressure. Even over-the-counter drugs such as cold remedies can cause drowsiness, while aspirin can cause stomach problems, bleeding and allergic reactions. The same principle applies to psychiatric medications. While very effective in controlling the painful emotional and mental symptoms, psychiatric medicines can produce unwanted side effects. People suffering from mental illness should work closely with their physicians to understand what medicines they are taking, why they are taking them, how to take them and what side effects to watch for.

Before deciding whether or not to prescribe a psychiatric medication, psychiatrists either conduct or order a thorough psychological and medical evaluation which may include laboratory tests. After a patient has begun taking a medication, the psychiatrist closely monitors his or her patient's health throughout the time the patient is taking the medicine. Often, the side effects disappear after several days on the medication; if they don't, the psychiatrist may change the dose or switch to another medicine that maintains the benefits but reduces the side effects. The psychiatrist may also prescribe a different medicine if the first one does not alleviate symptoms within a reasonable period of time.

Classes of Medications

Anti-depressant medications

Depression, which afflicts 9.4 million Americans in any six-month period, is the most common form of mental illness. Far different from the normal mood shifts everyone feels on occasion, depression causes a profound and unremitting sense of sadness, hopelessness, helplessness, guilt and fatigue. People suffering from depression find no happiness or joy in activities once enjoyed or in being with family and friends. They may be irritable and develop sleeping and eating problems. Unrecognized and untreated, depression can kill, as its victims are at high risk for suicide.

However, up to 80 percent of people suffering from major depressive disorder, bipolar disorder (manic-depression), and other forms of this illness respond very well to treatment. Generally treatment will include some form of psychotherapy and, often, a medication that relieves the excruciating symptoms of depression. Because people suffering from depression are likely to suffer from a relapse, psychiatrists may prescribe anti-depressant medications for six months or longer, even if the symptom s disappear.

Types of anti-depressant medication

Three classes of medication are used as anti-depre ssants: heterocyclic antidepressants (formerly called tricyclics), monoamine oxidase inhibitors (MAOIs) and serotonin-specific agents. A fourth medication--the mineral salt lithium--works with bipolar disorder. The benzodiazepine alprazolam is sometimes also used with depressed patients who also have an anxiety disorder (see section on anxiety disorder medications).

Taken as prescribed, these medications can mean the difference between life and death for many patients. Anti-depressant medications alleviate the terrible emotional suffering and give people a chance to b enefit from the non-drug therapies that enable them to deal with the psychological issues that may also be part of their depression.

Heterocyclic (Tricyclic) Antidepressants: This group of antidepressants comprises amitriptyline, amoxapine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, and trimipramine. They are safe and effective for up to 80 percent of all people with depression who take them.

At first, heterocyclics may cause blurred vision, constipation, a feeling of light-headedness when standing or sitting up suddenly, a dry mouth, retention of urine or feelings of confusion. A small percentage of people will have other side effects such as sweating, a racing heartbeat, low blood pressure, allergic skin reactions or sensitivity to the sun. Though bothersome, these side effects can be lessened with practical suggestions such as increasing fiber in the diet, sipping water, and getting up from a seat more slowly. They generally disappear after a few weeks, when the therapeutic effects of the medication take hold.

More serious side effects are extremely rare. However, a very small percentage of people being treated with these medications have aggravation of narrow-angle glaucoma and seizures.

As the bothersome side effects clear, the positive benefits of these medications take hold. Gradually insomnia clears up and energy returns. The person's self-esteem improves and the feelings of hopelessness, helplessness and sadness ease.

MAOIs: Though they are as effective as heterocyclic medications, MAOIs such as isocarboxazid, phenelzine, and tranylcypromine, are prescribed less frequently due to dietary restrictions their use requires. Psychiatrists will sometimes turn to these medications when a person hasn't responded to other anti-depressants. MAOIs also help depressed people whose health conditions--such as heart problems or glaucoma--prevent them from taking other types of medications.

People who take MAOIs should not eat foods such as cheese, beans, coffee, chocolate or other items that contain the amino acid tyramine. This amino acid interacts with MAOIs and causes a severe and life-threatening increase in blood pressure. MAOIs also interact with decongestants and several prescription medications. People using these anti-depressants should always consult their physicians before taking any other drug, and should rigorously follow dietary instructions.

Serotonin-specific agents: Serotonin-specific medicines--such as fluoxetine and sertraline--represent the newest class of medication for people suffering from depression. These medications have less effect on the cardiovascular system and therefore are helpful for depressed people who have suffered a stroke or heart disease. They generally have fewer side effects than other classes of anti-depressants.

However, during the first few days of taking them, patients may feel anxious or nervous, and may suffer sleep disturbances, stomach cramps, nausea, skin rash and, rarely, sleepiness. In extremely rare cases, a person may develop a seizure.

A few patients reported that, though they had no suicidal thoughts before taking fluoxetine, they developed a preoccupation with suicide after medication began. There have also been some reports that a very few patients developed violent behavior after beginning to take fluoxetine. Scientific data do not support these claims, however. No studies have shown that the medication itself caused these preoccupations or behaviors, which are also symptoms of depression.

Bipolar medications

People suffering from bipolar disorder go through phases of severe depression that alternate with periods of feeling normal and/or periods of excessive excitement and activity known as mania. During the manic phase, people have extremely high energy, develop grandiose and unrealistic ideas about their abilities, and commit themselves to unrealistic projects. They may go on spending sprees, for example, buying several luxury cars despite moderate income. They may go for days without sleeping. Their thoughts become increasingly chaotic; they speak rapidly and they may become quite angry if interrupted.

Lithium: The medication of first choice for bipolar illness is lithium, which treats both the manic symptoms in seven to ten days and reduces depressive symptoms when they may develop.

Though it is very effective in controlling the wild thoughts and behaviors of mania, lithium does have some side effects, including tremor, weight gain, nausea, mild diarrhea, and skin rashes. People taking lithium should drink 10 to 12 glasses of water a day to avoid dehydration. Adverse reactions which may develop in a small number of people include confusion, slurred speech, extreme fatigue or excitement, muscle weakness, dizziness, difficulty in walking or sleep disturbances.

Physicians also sometimes prescribe anticonvulsant drugs such as carbamazepine or valproate for people with bipolar disorder, though the FDA has not yet approved them for this purpose. It has been known to cause potentially serious blood disorders in a minority of cases.

Anti-anxiety medications

Anxiety disorders, in addition to generalized anxiety, include such disorders as phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Studies indicate that eight percent of all adults have suffered from a phobia, panic disorder or other anxiety disorder during the preceding six months. For millions of Americans, anxiety disorders are disruptive, debilitating and often the reason for loss of job and serious problems in family relationships.

Often an anxiety disorder, such as a simple phobia or post-traumatic stress disorder, responds well to psychotherapy, support groups and other non-medication treatments. But in severe cases, or with certain diagnoses, a person may require medicine to control the unrelenting and uncontrollable tension and fear that rule their lives.

Psychiatrists can prescribe highly effective medications that relieve the fear, help end the physical symptoms such as pounding heart and shortness of breath, and give people a greater sense of control. Psychiatrists often prescribe one of the benzodiazepines, a group of tranquilizers that can reduce debilitating symptoms and enable a person to concentrate on coping with his or her illness. With a greater sense of control, this person can learn how to reduce the stress that can trigger anxiety, developing new behaviors that will lessen the effects of the anxiety disorder.

Benzodiazepines, such as chlordiazepoxide, and diazepam, and several other medications effectively treat mild to moderate anxiety, but these medications should be taken for short periods. Side effects can include drowsiness, impaired coordination, muscular weakness and impaired memory and concentration, and dependence after long-term use.

Alprazolam, which is a high-potency benzodiazepine, is effective against anxiety disorders that are complicated by depression. People with this combination of symptoms who begin treatment may find that their anxiety symptoms worsen when they begin anti-depressant medication. Alprazolam helps control those anxiety problems until the anti-depressant takes effect. Though alprazolam works quickly and has fewer side effects than anti-depressants, it is rarely the medication of first choice because it has a high potential for dependency. Its side effects include drowsiness, impaired coordination, impaired memory and concentration, and muscular weakness.

Another anti-anxiety medication, buspirone, has different side effects than those sometimes caused by benzodiazepines. Though it has little potential for dependency and doesn't cause drowsiness or impair coordination or memory, buspirone can cause insomnia, nervousness, light-headedness, upset stomach, nausea, diarrhea, and headaches.

Medications for Obsessive-Compulsive Disorder

Obsessive-compulsive disorder -- which causes repeated, unwanted and often very disturbing thoughts and compels repetition of certain ritualistic behaviors -- is a painful and debilitating mental illness. A person with obsessive-compulsive disorder might, for instance, develop a fear of germs that compels him or her to wash his or her hands so often that they continually bleed.

Though obsessive-compulsive disorders are officially classified as anxiety disorders, they respond best to anti-depressant medications. In February 1990, the U.S. Food and Drug Administration (FDA) approved clomipramine, a heterocyclic anti-depressant, for use against obsessive-compulsive disorder. This medicine acts on serotonin, a neurotransmitter thought to affect mood and alertness. Though this medicine may not take full effect for two or three weeks, it is effective in reducing the uncontrollable thoughts and behaviors and the devastating disruptions they cause in a person's life.

Clomipramine's side effects, like those of all heterocyclic antidepressants, may include drowsiness, hand tremors, dry mouth, dizziness, constipation, headache, insomnia.

While its use in treating anxiety disorders has not yet been approved by the FDA, fluoxetine has shown some promise in research.

Anti-Panic Medications

Like other anxiety illnesses, panic disorder has both physical and mental symptoms. People suffering from a panic attack often think they are having a heart attack: their heart pounds; their chest is tight; they sweat profusely, feel they are choking or smothering, have numbness or tingling around their lips or their fingers and toes, and may be nauseated and chilled. Panic attacks are so terrifying and unpredictable that many victims may begin to avoid places and situations that remind them of those under which previous panic attacks occurred. Over time the victim may even refuse to leave home.

Currently, many psychiatrists may prescribe alprazolam for people who suffer with panic attacks. However, as already stated, this medication can cause dependency when used for an extended period. Once an anti-depressant has taken effect, physicians treating panic with alprazolam and an anti-depressant in tandem will usually reduce the alprazolam dosage slowly.

Learning new ways of thinking, modifying behavior, learning relaxation techniques and participating in support groups are among the non-medication treatments that are also important parts of the overall treatment plan for panic disorder.

While alprazolam is the only medication the FDA has approved for treatment of panic disorder, research continues into the positive effects of other medications as well.

In clinical trials panic disorder has responded well to heterocyclic anti-depressant medications. In fact, antidepressant medications such as imipramine have been effective in reducing panic symptoms in 50 to 90 percent of the patients studied. When combined with psychological and behavioral treatments, the effectiveness of the medications increases. When the panic symptoms lessen, the patient can begin working with the psychiatrist in understanding his or her illness and coping with its effects on daily life.

Likewise, studies have suggested that MAOIs such as phenelzine or tranylcypromine can be as effective as heterocyclic anti-depressants in the treatment of panic.

Fluoxetine, which is also awaiting FDA approval for treatment of panic, has had promising results in tests of its effects on panic.

Antipsychotic Drugs

Psychosis is a symptom, not a disease. It can be part of several mental illnesses, such as schizophrenia, bipolar disorder, or major depression. It also can be a symptom of physical illnesses such as brain tumors, or of drug interactions, of substance abuse, or of other physical conditions.

Psychosis alters a person's ability to test reality. A person may suffer from hallucinations, which are sensations that he or she thinks are real but don't exist; delusions, which are ideas which he or she believes despite all proof that they are false; and thought disorders, in which his or her thought processes are chaotic and illogical.

Schizophrenia is the mental illness most often associated with psychosis. Researchers do not know the specific causes of schizophrenia, though most believe that it is primarily a physical brain disease. Some believe that the neurotransmitter dopamine is involved with the hallucinations, delusions, thought disorders and blunted emotional responses of this mental illness. Most medications prescribed for schizophrenia affect the dopamine levels in the brain at the same time they reduce the extremely painful mental and emotional symptoms.

Anti-psychotic medications--acetophenazine, chlorpromazine, chlorprothixene, clozapine, fluphenazine, haloperidol, loxapine, mesoridazine, molindone, perphenazine, pimozide, piperacetazine, trifluoperazine, triflupromazine, thioridazine, and thiothixene--lessen the psychotic symptoms and allow the person to participate more fully in life.

Anti-psychotic medications do have side effects. They include dry mouth, blurred vision, constipation, and drowsiness. Some people taking the medications can experience a difficulty in urinating that ranges from mild problems beginning urination to complete inability to do so, a condition that requires prompt medical attention.

For many, these side effects lessen over several weeks as their bodies adapt to the medication. To lessen constipation, people taking antipsychotic medications can eat more fruits and vegetables, and drink at least eight glasses of water per day.

Other side effects include greater risk for sunburn, changes in white blood cell count (with clozapine), low blood pressure when standing or sitting up, akathisia, dystonia, parkinsonism, and tardive dyskinesia.

Patients with akathisia (which to some degree affects up to 75 percent of those treated with antipsychotic medications) feel restless or unable to sit still. While this side effect is difficult to treat, some medications among them propranolol, clonidine, lorazepam and diazepam can help. Those with dystonia (between one and eight percent of patients taking antipsychotic medications) feel painful, tightening spasms of the muscles, particularly those in the face and neck. This side effect is also treatable with other medications including benztropine, trihexyphenidyl, procyclidine, and diphenhydramine that act as antidotes. Parkinsonism is a group of symptoms that resemble those brought on by Parkinson's disease, including loss of facial expression, slowed movements, rigidity in arms and legs, drooling, and/or shuffling gate. It affects up to one third of those taking antipsychotic medications, and is also treatable with the medications mentioned for treatment of dystonia, with the exception of diphenhydramine. -

Tardive dyskinesia is one of the most serious side effects of anti-psychotic medications. This condition affects between 20 and 25 percent of persons taking antipsychotic drugs. Tardive dyskinesia causes involuntary muscular movements, and though it can affect any muscle group, it often affects facial muscles. There is no known cure for these involuntary movements (though some drugs, including reserpine and levodopa may help) and tardive dyskinesia may be permanent unless its onset is detected early. Psychiatrists emphasize that patients and their family members should watch closely for any signs of this condition. If it begins to develop, the physician can discontinue the medication.

Clozapine, which the FDA approved for prescription in 1990, now offers hope to patients who, because they suffer from so-called "treatment resistant" schizophrenia, could not be helped before by anti-psychotic medications. Though clozapine has not been associated with tardive dyskinesia, this anti-psychotic medication does cause a serious side effect in one to two percent of the people who take it. This side effect--a blood disorder called agranulocytosis--is potentially fatal because it means the body has stopped producing the white blood cells vital to its protection from infections. To guard against development of this condition, the medicine's manufacturer requires weekly monitoring of the white blood cell count of each person taking the medication. As a result, use of clozapine and its accompanying monitoring system can be expensive.

Though anti-psychotic medications have side effects, they offer benefits that far outweigh the risks. The hallucinations and delusions of psychosis can be so terrifying that some people are willing to endure their side effects for relief from the terrors of the illness. The thought disorders can be so confusing and frightening, they isolate those afflicted with them in a lonely world from which no escape seems possible. Unable to know whether the insects they see crawling on their bodies are real, unable to control the voices that harass and degrade them, unable to express their thoughts so others can understand them, people suffering from psychotic symptoms lose their jobs, their friends and their families. Cast into a hostile world of people who are afraid of or unable to understand their disease, these people often become suicidal.

For comprehensive information on specific psychiatric medications visit the HealthyPlace.com Psychiatric Medications Pharmacology Center here.

Extensive information on Psychiatric Medications Treatment here.

Conclusion

No medication, whether an over-the-counter drug such as aspirin or a carefully prescribed psychiatric medication, is without side effects. But just as relief from the pain and discomfort of a cold is worth the potential side effect, so is the relief from the excruciating and potentially fatal symptoms of mental illnesses. Psychiatrists are trained to carefully weigh the benefits and risks of prescribing these medications.

No one should fear taking a psychiatric medication if he or she has received a complete medical and physical examination and is properly monitored for both the medicine's benefit and side effects. Not only do psychiatric medications offer relief from the terror, loneliness, and sorrow that accompany untreated mental illnesses, but they enable people to take advantage of the psychotherapy (which psychiatrists usually prescribe in tandem with medication), self-help groups, and supportive services available through their psychiatrist. Better, these medications and the other services available through mental health care enable people who have mental illness to enjoy their lives, their families and their work.

Find out about specific psychiatric medications

(c) Copyright 1993 American Psychiatric Association
Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This document contains the text of a pamphlet developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.

Additional Resources

Andreasen, Nancy. The Broken Brain: The Biological Revolution in Psychiatry. New York: Harper and Row, 1984.

Gold, Mark S. The Good News About Depression: Cures and Treatments in the New Age of Psychiatry. New York: Villard Books, 1987.

Gold, Mark S. The Good News About Panic, Anxiety & Phobias. New York: Villard Books, 1989.

Goodwin, Frederick K. Depression and Manic-Depressive Illness in Medicine for the Layman. Bethesda, MD: U.S. Department of Health and Human Services, 1982.

Gorman, Jack M. The Essential Guide to Psychiatric Drugs. New York: St. Martin's Press, 1990.

Greist and Jefferson, Eds. Depression and its Treatment: Help for the Nation's Number One Mental Problem. Washington, DC: American Psychiatric Press, Inc., 1984

Henley, Arthur. Schizophrenia: Current Approaches to a Baffling Problem (pamphlet). New York: Public Affairs Pamphlets, 381 Park Ave. South, NY, 1986.

Moak, Rubin, Stein, Eds. The Over-50 Guide to Psychiatric Medications. Washington, DC: American Psychiatric Press, Inc., 1989.

Sargent, M.Depressive Illnesses: Treatments Bring New Hope. U.S. Department of Health and Human Services (ADM 89-1491), 1989.

Torrey, E. Fuller. Surviving Schizophrenia: A Family Manual. New York: Harper and Row, 1988.

Walsh, Maryellen. Schizophrenia: Straight Talk for Families and Friends. New York: William Morrow and Company, Inc., 1985.

Yudofsky, Hales, and Ferguson, Eds. What You Need to Know About Psychiatric Drugs. New York: Grove Weidenfeld, 1991.

Other Resources

Anxiety Disorders Association of America
(301) 231-9350, (703) 524-7600

National Depressive and Manic Depressive Association Merchandise Mart
(312) 939-2442

National Institute of Mental Health Public Information Branch
(301) 443-4536

National Mental Health Association
(703) 684-7722

more on: pharmacology of specific psychiatric medications - use, dosage, side-effects.

back to: Psychiatric Medications Pharmacology Homepage

Detailed overview of psychiatric hospitalization. Why psychiatric hospitalization is needed, what to expect, involuntary commitment to a psychiatric hospital and more.

Facts About Psychiatric Hospitalization

Hospitalization for psychiatric illness has undergone revolutionary changes in the last three decades. At mid-century, there were two basic sources of care for people with mental illnesses: a psychiatrist's private office, or a mental hospital. Those who went to the hospital often stayed for many months, even years. The hospital, frequently operated by the state, offered protection from the stresses of living which could be overwhelming for those with severe illness. It also offered protection from self-inflicted harm. But it offered little in the way of treatment. The use of medication as a mainstay of rehabilitative treatment had just begun.

Today people with a mental illness have many treatment options depending upon medical need: 24-hour inpatient care in general hospital psychiatric units, private psychiatric hospitals, state and federal public psychiatric hospitals and Veterans Administration (VA) hospitals; partial hospitalization or day care; residential care; community mental health centers; care in the offices of psychiatrists and other mental health practitioners, and support groups.

In all these settings, health care professionals work very hard to provide care according to a treatment plan developed by each patient's psychiatrist. The goal is to restore maximum independent living as rapidly as possible, using the appropriate level of care for the appropriate illness. Frequently, the family is involved as part of the treatment team.

Today, people turn to psychiatric hospitals for help with a wide range of mental illnesses: families coping with the ravages of addiction; a young mother or a grandfather fighting depression; a girl whose eating disorder has put her life in danger; a young executive who cannot shake compulsions that threaten to take over his life; a once-prominent attorney who is nearly a prisoner in her own home because of phobias and anxiety; a veteran of the Vietnam war who can't seem to get over the pain of his past; a youngster whose uncontrollable and destructive behavior threatens to tear her family apart; a college freshman who is frightened and confused by strange voices and delusions.

When Psychiatric Hospitalization is Needed

A psychiatrist's decision to admit a patient to the hospital depends primarily on the severity of the patient's illness. No one is sent to the hospital who can better be treated in the psychiatrist's office or in another less restrictive setting. The presence or absence of social support--family members or other caretakers--can also figure in the psychiatrist's decision to hospitalize a patient. With sufficient social support, a person who might otherwise require hospitalization can often be cared for at home.

In much the same way a physician decides to hospitalize a person for other medical illnesses, the psychiatrist--who is a medical doctor--evaluates the symptoms to determine a treatment plan and the most appropriate treatment setting.

The procedure for hospital admission for a psychiatric illness resembles that for other illnesses. Often, that means a person's health insurance company may require a pre-admission certification before agreeing to pay for a hospitalization. Working with the psychiatrist, insurance company staff will review a patient's case and decide if it is serious enough to require inpatient care. If so, they will approve admission for a limited hospital stay, then periodically review the patient's progress to determine whether the stay should be extended. If care is denied, the psychiatrist and patient may appeal.

What to Expect in a Psychiatric Hospital

Many psychiatric hospitals and mental health units of general hospitals provide the full range of care, from psychotherapy to medication, from vocational training to social services.

Hospitalization reduces the stresses of responsibility for the patient for a brief time and allows the person to concentrate on recovery. As the crisis lessens and the person is better able to assume the challenge, the mental health care team can help him or her to plan for discharge and the community-based services that will help him or her to continue recuperating while living at home.

People in the hospital receive treatment that follows a plan developed by the psychiatrist. The therapies outlined in that plan may involve a variety of mental health professionals: the psychiatrist, a clinical psychologist, nurses, social workers, activity and rehabilitation therapists and, when necessary, an addiction counselor.

Before psychiatric treatment in any hospital begins, a patient undergoes a complete physical examination to determine the overall state of his or her health. Generally, once treatment begins, patients in the hospital receive individual therapy with a primary therapist, group therapy with peers, and family therapy with spouse, children, parents or other significant people. At the same time, patients often receive one or more psychiatric medicines. During therapy sessions, a patient can develop insights into his or her emotional and mental functioning, learn about his or her illness and its effect on relationships and daily living, and establish healthy ways of responding to the illness and daily stresses that can affect mental health. In addition, patients can receive occupational therapy to develop skills for daily living, activity therapy to learn how to develop healthy social relationships in the community, and drug and alcohol evaluation. Throughout the hospital stay, each patient works with his or her treatment team to put together a plan for continued care after the hospital stay is over.

continue: Length of Stay and Putting a Child in a Psychiatric Hospital

Residential treatment programs are categorized as either medically based or socially based. In medically based programs patients receive very structured care, including such services as medically necessary supervision and psychotherapy. In socially based programs patients receive psychotherapy, but also learn how to take advantage of community support systems and increase their independence. For example, under a socially based program, patients learn how to apply for government medical assistance that will enable them to get psychiatric and medical services in the community rather than relying on hospitalization for help.

Residential care can also help patients to learn how to maintain a household, cooperate with other residents and work with social and health agencies to get the services they need. This, in turn, improves their self-esteem and confidence.

Hospital personnel pay careful attention to the physical well being of patients. Hospital physicians and nurses monitor the patient's medications, and, with those patients whose severe illnesses may make them a danger to themselves or other patients, take steps to protect them from injury. This can sometimes mean use of restraints or isolation from other patients, measures that are used to protect, not to punish, and only for very brief periods of time. Hospital personnel also work to be sure each patient understands the importance of good nutrition and knows the dietary restrictions that may be necessary because of his or her medications.

Length of Stay

Today the average length of stay for adults in a psychiatric facility is 12 days. The mental health care team and patient begin planning for discharge on the first day of admission. Because medical research has produced highly effective treatments, people who suffer from mental illness today recover from severe episodes much more quickly than in the past.

Likewise, people who suffer from alcohol and substance abuse no longer routinely stay in residential treatment centers for prolonged periods of time. Most recover with short-term stays that average 10 days, followed by partial hospitalization, outpatient and support group services.

Other Psychiatric Hospitalization Options

Once psychiatric treatment stabilizes a patient's condition, he or she may progress to a less-intensive treatment setting. The psychiatrist may recommend partial hospitalization. This option isn't limited to people who are ending a hospital stay; it also meets the needs of people who live in the community and need a higher level of care without the services of overnight, 24-hour nursing.

Partial hospitalization provides individual and group psychotherapy, social and vocational rehabilitation, occupational therapy, assistance with educational needs, and other services to help patients maintain their abilities to function at home, at work and in social circles. However, because their treatment setting helps them to develop a support network of friends and family that can help monitor their conditions when they are not in the hospital, they can return home at night and on weekends. Partial hospitalization or day treatment works best for people whose symptoms are under control. They enter care directly from the community or after being discharged from 24-hour care.

Partial hospitalization is most effective for patients who are ready for therapy and rehabilitation that can move them comfortably back into the community. It is also less expensive. A full day of partial hospitalization costs, on average, $350--roughly half the cost of 24-hour inpatient treatment, according to Health Care Industries of America, a health care consulting company.

When Children Need Psychiatric Hospital Care

Children and teenagers can have mental illnesses. Some of these illnesses--such as conduct disorder and attention deficit/hyperactivity disorder--usually emerge during these early years. Youngsters also can suffer with illnesses most people would associate first with adults, such as depression or schizophrenia. And like those of adults, children's illnesses can go into remission or worsen from time to time.

When a child's symptoms become severe, a psychiatrist may recommend hospitalization. The physician will consider several factors in making the recommendation:

• Whether the child poses an actual or imminent danger to him or herself or others;
• Whether the child's behavior is bizarre and destructive to the community;
• Whether the child requires medication that must be closely monitored;
• Whether the child needs 24-hour care in order to become stabilized;
• Whether the child has failed to improve in other, less restrictive environments.

As with adults, children receiving inpatient care will have a treatment plan that identifies the therapies and goals unique to each child. The treatment team will work with each child in individual, group and family therapy as well as occupational therapy. Youngsters are also often involved in activity therapy, which teaches social skills, and drug and alcohol evaluation and treatment. In addition, the hospital will provide an academic program.

Because the family is integral to a child's recuperation, the treatment team will work closely with parents or guardians to ensure good communication and understanding about the illness, treatment process and recovery prognosis. Families will learn how to work with their children and cope with the stresses that can develop with a serious or chronic illness.

continue: Involuntary Treatment in a Psychiatric Hospital

Involuntary Treatment - Commitment to a Psychiatric Hospital

The National Association of Psychiatric Health Systems reports that about 88 percent of adults treated in its members' hospitals are admitted voluntarily. In many states, people so disabled by their illnesses that they don't fully recognize the need for 24-hour inpatient care and who refuse hospital treatment may be involuntarily admitted to the hospital, but only with the knowledge of the court system and following an examination by a physician.

Commitment procedures vary from state to state. There has been some attempt made to shield mentally ill people from the stigma of public court appearances, and sometimes patients can be too ill to attend a hearing. For these reasons, a mentally ill person may, in some states, be admitted on the advice of one or two physicians who act within a very strict set of procedures to insure full protection of the patient's legal rights. Most states allow a physician to prescribe that a person be admitted involuntarily to a hospital for a brief evaluation period, usually three-days.

During the evaluation period, a team of psychiatrists and mental health professionals can learn whether the person's illness requires longer hospital care or can be managed effectively with less intensive treatment, such as partial hospitalization.

If the evaluation team thinks a patient requires inpatient care past the three-day period, it can request longer admission--a request that, it should be emphasized, is subject to a hearing. At this hearing, the patient or his or her representative must be present. No decisions regarding a patient's hospitalization and subsequent treatment can be made without the presence of the patient or this representative. If involuntary admission is recommended, the court can issue an order for only a specific period of time. At the end of that period, the question of hospitalization must again go to a court hearing.

Involuntary treatment is sometimes necessary, but is used only in unusual circumstances and is always subject to a review which protects the civil liberties of patients.

There if You Need it

If your physician prescribes hospitalization, you, a member of your family, a friend or other advocate should tour the recommended facility and learn about its admissions procedure, daily schedules and the mental health care team with whom you or your family member will be working. Learn how treatment progress will be communicated and what your role will be. This may help you to feel more comfortable about complying with your physician's recommendation. And that comfort can only contribute to the progress you or your loved one will make during hospital care.

Regardless of the illness, it's good to know that a range of health care services are available for patients and their families. Certainly outpatient care is the most common treatment setting. But when an illness becomes severe, effective hospital services are there to meet the need.

For comprehensive information on psychiatric hospitalization and mental illness, visit the HealthyPlace.com Mental Illness Information Center here.

back to: Psychiatric Disorders Definitions Index

(c) Copyright 1994 American Psychiatric Association

Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This document contains text of a pamphlet developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.

Additional Resources

Dalton, R. and Forman, M. Psychiatric Hospitalization of School-Age Children. Washington, DC: American Psychiatric Press, Inc., 1992.

Consent to Voluntary Hospitalization: Report of the American Psychiatric Association Task Force on Consent to Voluntary Hospitalization. Washington,DC: American Psychiatric Press, Inc., 1992.

Facts for Families Information Sheet Series, "Children's Major PsychiatricDisorders," and "The Continuum of Care." Washington, DC: American Academyof Child and Adolescent Psychiatry, 1994.

Kiesler, C. and Sibulkin, A. Mental Hospitalization: Myths and Facts About A National Crisis. Newbury Park, CA: Sage Publications, 1987.

Korpell, H. How You Can Help: A Guide for Families of Psychiatric Hospital Patients. Washington, DC: American Psychiatric Press, Inc., 1984.

Krizay, J. Partial Hospitalization: Facilities, Cost & Utilization.Washington, DC: The American Psychiatric Association, Inc., 1989.

Policy Statements on Inpatient Hospital Treatment of Children and Adolescents. Washington, DC: American Academy of Child and AdolescentPsychiatry, 1989.

back to: Psychiatric Disorders Definitions Index