Zabrin Inan,ADD/ADHD,mood disorders,depression,eating disorders,anxiety

Dr. Zabrin Inan, MD
Child, Adolescent and Adult Psychiatry
Chicago

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FAQ about Mental Health

Here are some common questions about mental health and
Dr. Inan's approach to treatment:

How common are mental health disorders? 

Do you specialize in specific types of mental health disorders?

How do you evaluate my needs?

How are medications used in treatment?

How do you determine if I need medication and the dosage?

What is the difference between a psychiatrist, a psychologist and a therapist?

What happens if I want to change to a different mental health provider,
or you refer me to another mental health provider?

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How common are mental health disorders? 

Mental health disorders are as common as physical health disorders.  They are as real biologically as heart disease, asthma, diabetes and other physical disorders, and can be just as debilitating.  They are diagnosable, and they are treatable.

In any given year, 1 out of 5 children, adolescents and adults will suffer from a mental disorder that causes some impairment.  Research by the U.S National Institute of Mental Health (NIMH) shows:

  • 22% of Americans age 18 and older�about 1 in 5 adults or over 44 million adults�suffer from a diagnosable mental disorder.   
  • 21% of U.S. children ages 9 to 17 will suffer a diagnosable mental or addictive disorder that causes at least some impairment.  Of these, half or 11% will have more serious difficulties.
  • Children under 9 years old suffer from mental health disorders at the same rate.  It was also once thought that mood disorders such as anxiety, depression and bipolar disorder did not occur in childhood. We now know they can begin in early childhood.  We also know that ADHD (attention- deficit/hyperactivity disorder) itself has a high degree of comorbidity, including anxiety disorders (20-25%), mood disorders (15-20%) and conduct disorders (15-20%). 

In fact, it is estimated that up to 20% of children and adolescents�worldwide�have one or more diagnosable and treatable disorder, according to World Health Report 2001, Mental Health: New Understanding, New Hope.

Recent evidence compiled by the World Health Organization indicates that by the year 2020, childhood neuropsychiatry disorders will rise proportionately by over 50% worldwide to become one of the five most common causes of morbidity, disability and mortality.

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Do you specialize in specific types of mental health disorders?

Yes, I specialize in Attention Deficit Disorders, Mood Disorders, which include the various types of depression, Anxiety Disorders, Stress-related disorders and Eating Disorders.  You may click on the specific disorder below for an overview and other recommended websites for additional information:

Attention Deficit Disorders

Mood Disorders

Anxiety  and Stress-related disorders

Eating Disorders

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How do you evaluate my needs?

Every diagnosis requires a comprehensive assessment that includes a review of patient developmental; social, academic, family and medical history; and an analysis of all symptoms.

  1. I may ask you to download and complete an assessment form or self-test form prior to your first visit, as well as provide a complete family and medical history.
  2. During our appointment, we will thoroughly review this information, clarifying, expanding and adding specific information  It is very important that we be open with each other, and that you be willing to talk about any concerns such as substance use, other medical conditions, family history, and even personal fears.  I will not make a diagnosis without a complete picture. 
  3. All patient information is absolutely confidential.
  • All psychotherapy notes are maintained in a secure file strictly apart  from the patient medical record. Psychotherapy notes are not part of the medical record and are not intended for release. The Health Insurance Portability and Accountability Act (HIPPA) specifically protects the privacy of psychotherapy notes, which are defined as �notes recorded (in any medium) by a mental healthcare provider documenting or analyzing the contents of a conversation during a private, group, joint or family counseling session and that are separated from the rest of the individual�s medical record.� 
  • The patient medical record includes diagnosis, medication prescription record, session start and end times, modalities and frequencies of treatments, results of clinical tests, and needed summary of diagnosis, functional status, treatment plan, symptoms, and prognosis.
  1. During the first phase of treatment, I ask patients to keep a daily diary.  It need not be elaborate; sometimes �good day� is enough.  But it is important for the patient or guardian to track any increases, decreases or other changes in the types of stressors in daily life.  Many of my patients have found that their diary is helpful throughout their treatment, and continue to maintain a diary. The information in the diary is to be shared with me during treatment sessions or in phone consultations.  Do not fax  or e-mail your diary to me.
  2. Finally, because patient participation in searching out the road to well-being is critical to the success of treatment, I encourage patients to actively research their disorders.  The Internet is a rich source of information; however, it is also a rich source of misinformation. Don�t hesitate to ask questions, and to use the links on this website for research.  When you find a self-test or a link not on this site but that you found useful, let me know; it may be one that we should share with others. It is important that patients are actively involved in finding the road to well-being.

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How are medications used in treatment?

Medications reduce or control symptoms of the disorder, and help the patient function as well as a person who does not have the disorder.  When symptoms are successfully controlled, patients can more effectively focus on the issues that affect their lives and use their experience to live more happily and productively.

Medications that treat symptoms are not a cure.  As with certain physical illnesses, medications can control the symptoms of mental health disorders but do not cure the disorders.

For example, just as insulin reduces or controls the symptoms of diabetes but does not cure it, psychotherapeutic medications reduce or control the symptoms of depression.

There is no "one size fits all� medication regimen.

  • Many depressed and anxious people, for example, may need medication for a single period�perhaps for several months�and then never need it again.

  •  Others, whose depression or anxiety is chronic or recurrent, may have to take medication indefinitely. This is no different than taking insulin for diabetes.

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How do you determine if I need medication and what dosage I would need?

Medication is prescribed after a thorough evaluation of symptoms and diagnosis.  In some instances, I may ask that the patient�s primary care physician make a complete physical examination, or I may refer the patient to a neurologist for specific tests before prescribing medications. 

Specific medications and timepoints, that is, the dosage, time of day and sequence, are determined by an individual�s needs.  Factors that enter into this decision include: 

  • individual metabolism
  • severity of a specific symptom
  • comorbid disorders
  • changes in environmental stressors 

Let�s look at these factors more closely:  

Individual metabolism�every individual absorbs, metabolizes and excretes medications differently.  For example, because medications have shorter half-lives in children and adolescents than in adults, size or weight is only one of many factors to be considered when determining the dosage for optimum treatment.

Specific symptoms, the severity of those symptoms and any comorbid or related disorders must be taken into account.  For example, people who suffer a mood disorder such as depression also may suffer anxiety symptoms or disorders, which include panic disorder.  Depending upon the severity of  symptoms and comorbidity, we may initiate a mood stabilizing medication and an antidepressant medication.  People with panic disorder sometimes are highly sensitive and fearful of physical sensations.  In those cases, there are medications that can be used initially to mediate the body�s initial adjustment to the mood stabilizer and antidepressant. 

Contrary to what you may read or hear in the popular media, ADHD is not a simple disorder. ADHD itself has a high frequency of comorbidity, including mood disorders (15-20%) and anxiety disorders (20-25%).  It was once thought that mood disorders and anxiety disorders began only after childhood.  We now know that a child can have early onset of both ADHD and a mood disorder.  

Because the conventional treatment for ADHD, a stimulant, worsens the mood disorder, we now rule out or confirm a mood disorder before treating the ADHD with a stimulant.  If a child, adolescent or adult has both ADHD and a mood disorder, we initiate a mood stabilizer to control the mood disorder, and stimulant medication to treat the ADHD.  

Changes in environmental stressors at work, home, school and related interpersonal relationships can affect metabolism.  They must be closely monitored during the initial stages of treatment, and the medication adjusted accordingly.  Patients will be asked to keep a diary of any positive or negative changes in stressors in their daily lives.  It need not be elaborate; �good day� is sometimes enough, but a record of change is important.

Patients must take all medications as prescribed�at the time of day, in the sequence, and at the dosage prescribed.  These are the �timepoints� and are important when adjusting the medications to individual metabolism and any changes in environmental stressors.  Patients must not discontinue any medications without a personal consultation with me.  Initial side effects typically disappear as the body adjusts. Routine lab tests are also used to monitor the body�s chemistry as it adjusts to the medication.

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What is the difference between a psychiatrist, a psychologist and a therapist?

Psychiatrists are medical doctors (M.D.) who specialize in treating mental disorders. They must be licensed in the state in which they practice, and are licensed by the U.S. Drug Enforcement Agency to prescribe medication.  Some states also require a state controlled substance license in addition to licensing as a physician.  

Of the 45,000 psychiatrists in practice in the U.S., only 15% are Child, Adolescent and Adult Psychiatrists.  Psychiatrists provide combined medication management and therapy, and many specialize in specific disorders. Training to be an Adult Psychiatrist includes a 4-year bachelor's degree, usually with pre-medical studies as a major; 4 years of medical school and a 3-year residency in psychiatry.  

A Child, Adolescent and Adult Psychiatrist first completes the training to be an Adult Psychiatrist, and then completes an additional 2-year residency in Child Psychiatry, which includes in-depth focus on pediatric psychopharmacology.  Psychiatrists are Board Certified by the American Board of Psychiatry and Neurology, a member of the American Board of Medical Specialties.

Psychologists have a PhD in psychology and must be licensed in the state in which they practice.  While anyone who has obtained a 4-year psychology degree may call themselves a Psychologist, the term �psychologist� is generally reserved for those who hold a PhD, have completed an internship under supervision, and are licensed by the state in which they practice.  

Psychologist training includes a 4-year bachelor�s degree, often with psychology studies as a major, an average of 7 years� graduate education training and research before receiving a doctoral degree, and completion of a supervised internship.  Psychologists must be licensed by the state in which they practice, and often specialize in specific types of counseling and disorders.   

PhD level psychologists often are members of the American Psychological Association, which has 53 professional divisions and 150,000 members.  Psychologists cannot prescribe medication except in the State of New Mexico and then only under certain conditions and guidelines (see www.nmbme@state.nm.us).

Therapists usually have a master's degree and have completed an internship under supervision. Therapist social workers may carry the titles MSW (Masters of Social Work) or LCSW (Licensed Clinical Social Worker). 

Like psychiatrists and psychologists, therapists often specialize in specific types of counseling and disorders.  While some states do not require a therapist to be licensed by a state regulatory board, most therapists are accredited (based on strong criteria of training and education) by professional organizations, such as The National Association of Social Workers, which has 150,000 members. You can confirm whether a state license is required in your state and held by a therapist by going to the web site of your state�s Board of Professional Licensing and Regulation or state Medical Board. Therapists cannot prescribe medications.

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What happens if I want to change to a different mental health provider,
or you refer me to another mental health provider?

The focus is on continuity of care. You and I will meet to review your diagnosis, history of symptoms, treatment program and medication regimen, and discuss any concerns you may have about the release of specific information.  You can keep a copy of the written summary of our review, and a copy of your medical record can be provided to you.  With your written authorization to release information, identifying the specific information to be released, your medical records and the summary of our review will be sent via receipted overnight mail to the mental health care provider of your choice. 

You will be mailed an itemized bill for copying and sending records. Copying charges generally are $35 and Federal Express overnight mail averages $25. All records are sent via overnight Federal Express to ensure signed confirmation of receipt by the recipient or organization.

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  Chicago



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