Psychiatry

The general psychiatry consultation aims to assess and treat pathologies such as anxiety disorder, bipolar affective disorder, depression, psychotic disorders (such as schizophrenia), substance-induced psychoses, obsessive-compulsive disorder, disorders associated with aging (such as memory changes and dementia, as well as behavioural changes). This consultation is conducted by a psychiatrist and has several steps:

• • First step: the physician meets and gets to know the person, through questions surrounding remarkable events, relationships with friends and family, tastes, preferences;
  • Second step: the physician identifies difficulties and cause of suffering and/or dysfunction, and characterise the symptoms, which can be a combination of sadness, lack of energy, anger, anguish, and difficulties in reasoning, remembering, or concentrating on tasks;
  • Third step: the physician identifies modifiable habits and lifestyles that can contribute to improved mental health and help combat symptoms of illness, such as increased physical activity, improved social interaction, or maintenance of daily routines;
  • Fourth step: the physician is, then, ready to formulate a diagnosis and a treatment plan, which may include psychotropic drugs, psychotherapy, transcranial magnetic stimulation, or electroconvulsive therapy. The goal of treatment is to restore balance and well-being, eliminate symptoms of disease, and improve executive function – that is, to allow the person to be in charge of their full capabilities, in the personal, familial, or professional spheres of their life.

Performed simultaneously by a psychiatrist and a psychologist:

• • Resistant Depression/Anxiety/Burnout Consultation
  • Adult ADHD Consultation
  • Obsessive Compulsive Disorder Consultation
  • Perinatal Consultation (from preconception to family changes/postpartum depression)
  • Assessment of the elderly, memory, and behavioural alterations.
  • Psychosis/schizophrenia Consultation.

In these consultations a psychiatrist and a psychologist conduct the patient assessment simultaneously. It simplifies the usual process – first being seen by a psychiatrist, then being referred to a psychologist – which prevents the patient to have to repeat their entire clinical history. The specialised psychiatry consultation allows for combined clinical assessment, with both the perspective of Psychiatry and Psychology, and reduces the total number of consultations required for treatment.

Medications, when appropriate for the pathology and the person, and in the right doses and combinations, are very safe and effective, well tolerated and with few side effects. When used correctly as prescribed, medications do not cause drowsiness, habituation (development of tolerance), nor dependence (addiction), even if they are used for extended periods – the same way medications to treat other diseases such as diabetes, and which are used for long periods do not either. At Joaquim Chaves Saúde, in addition to the mastery and experience in the use of psychotropic drugs, we have at our disposal a wide range of laboratory tests, which allow us to optimise dosages according to blood concentration.

TMS is a form of stimulation through strong magnetic pulses capable of modifying neuronal activity. When applied repeatedly on a certain area of the brain, these pulses have the ability to improve pathologies such as drug-resistant depression or obsessive-compulsive disorder. At Joaquim Chaves Saúde, we have state-of-the-art TMS equipment, provided by Brainsway.

This technique has been known for several decades for its effectiveness. However, it gained bad reputation after having been used in many situations where it was not warranted. Over last 30 years, nevertheless, this technique has been continuously developed and perfected, and is now applied by a complex, sophisticated equipment within controlled parameters adjusted to each patient.

ECT consists of the application of an electrical stimulus in order to "synchronise" all neuronal networks, leading to a simultaneous release of multiple neurotransmitters, neuronal growth factors, and even hormones. It is the most effective treatment for severe or treatment-resistant depression, and its administration lasts a few minutes, under anaesthesia and muscle relaxation, rendering it painless. At JCS, we have an experienced team and the most advanced equipment available - the SIGMASTIM.

Also known as S-ketamine, is a treatment indicated for adults with treatment-resistant depression, who have not had an improvement in symptoms with other treatment methods. As part of a comprehensive approach, esketamine is made available alongside other therapies, adapting to the specific needs of each patient. This treatment also has other advantages:

• • It is easily administrated via nasal spray;
  • It is safety-focused, being administered under direct medical supervision;

It has an innovative mechanism of action, as it acts on the glutamatergic system of the brain, which is an important factor in cases where depressive symptoms have not responded to other treatments.