Online Journal / UP News

Saturday, March 12, 2022, 8:00 a.m.
– Text: Ivana Pustějovská

When you go to visit him in the hospital, almost everyone you mention the destination to you will not forgive you for the humorous phrase: “Just to let you go again.” with a slight smile before visiting the door keys. Along with his sense of humor, however, he coded caution as a key characteristic. He knows that each word can mark human destinies. Professor Klára Látalová, Head of the Department of Psychiatry, Faculty of Medicine, Palacky University and University Hospital of Olomouc.

The interview was brought by the current magazine Žurnál UP and we are now posting it online.

We have been fighting a pandemic for two years. We still read and hear the figures of the infected, of the dead. It is probably natural for a person to be afraid of himself, his loved ones. When is fear still acceptable and when should you seek an expert?

The moment when fear or anxiety paralyzes you and is so compelling that it seems to immobilize you at some point. It can also be crippling in a physical sense. You stop working, you are unable to decide common things like what now, what next, whether you are wearing a long or short sleeved T-shirt. This everyday trifle will reach such proportions that you will not be able to solve more important things. Then you should ask for help.

Can I find out for myself? The limit at which I don’t feel well?

There is an answer from Solomon to this: to some extent, yes. At some point, we are capable of feeling mental unease, tension, anxiety, or malaise that we often don’t even have the vocabulary for. We simply cannot name what is going on inside us. People usually don’t have words in their vocabulary such as tension, inner tension, mixed feelings, loss of motivation. And if the methods or procedures we’ve usually used in these situations aren’t helping our internal discomfort, then now is a good time to seek help elsewhere.

The Covid can “sign” on the lungs, heart and other organs. Can it affect our brain?

Yes, data has already been published indicating that the effects are also felt in the brain. It can be a change in cognitive functions, that is to say in information processing, processing speed, a change in judgment. But the effects can also be in the direction of short-term effects, such as increased anxiety and, above all, persistent anxiety unrelated to external stimuli. I think of the inexplicable anguish that still persists, even though there is no longer any real threat. We sometimes talk about the effects of covid and the so-called brain fog, i.e. the inability to decide, to rejoice, to relax, simply to experience the ordinary joys of life.

How to get out?

We do not yet fully understand the repair processes that may occur. We have information that, for example, conventional antidepressants or commonly available medications are not as effective in these post-anxiety anxieties as they are in other types of anxiety. We collect even more data. Today we already have patients who, even a year after suffering covid, are anxious and have no other health problems.

Did anything surprise you during the pandemic, like people’s behavior?

Honestly, nothing surprised me. Not even the division of society, for example, on the question of vaccination and non-vaccination. I know from my psychiatric practice that even repeated medical recommendations and advice based on scientific evidence and practice are often not respected and followed by patients. And even at the cost of irreversible damage to people’s health. For some of them, their freedom is so important that they even follow the path of self-destruction.

It is freedom and “freedom”.

Yes, but we in psychiatry are constantly confronted with it and so are other medical disciplines. For example, smokers follow the path of self-destruction. The current situation is different in that it not only limits and devastates these individuals, but also affects the lives and comforts of others.

Has the pandemic brought anything new to your profession?

I work with a part of the population suffering from mental disorders and they did not bring any new information on this subject. But she showed us how the mentally sane majority behaved in these situations, which manifested themselves in the media and in the public space. And when we know that about nineteen percent of people suffer from some form of mental disorder, we can wonder if the actions of the majority society, with which we are confronted on a daily basis, should calm us down or disturb us.

Nineteen percent of the population has a mental illness?

This is generally valid data that one in five people does not directly suffer from a mental illness, but from a mild disorder, whether it is insomnia, difficulty concentrating, anxiety or phobia.

If a fifth of the population has psychological problems, how many of them turn to an expert? Does this number match?

Certainly yes, in the long term the demand for psychiatrists is greater than the supply. Some regions are not covered by a psychiatrist, prescription times are long, there are no child psychiatrists, there is an increase in adolescents for whom there is no specialized care.

The stigma always works in the sense: I’m not crazy, why would I go to a psychiatrist?

There is a wide range of opinions, on each side of which there is an extreme: There are people who come to the psychiatrist with a banality that can border on a certain tension to ask for help for every little thing. And then there is the other extreme, when a person’s condition has been bad for many years, he does not work at work or in the family, but he does not seek an expert. There is often the aforementioned stigma, and before people go to the doctor, they prefer to be at home, supported by family. But these are rarities. It also depends on the region and the possibilities. We are talking about a regional town where there is good access to professional care, but you can travel a few tens of kilometers to the north and the situation will be significantly different.

What are the limits of psychiatry?

Generally speaking, the limits lie in the complexity of the brain, which is almost limitless. In particular, the biggest limitation of psychiatry is the fact that it does not have biomarkers like other fields. Imagine this using the example of internal medicine, such as blood pressure measurement, where a professional institution determines that the level of hypertension is so and so. You have a specific generally accepted statement. In psychiatry, these things are consensual, entry criteria for diagnosis are established based on consensus and long-term refinement of diagnostic criteria to suit billions of populations and be applicable to all cultures. As we do not have these biomarkers, we pay great attention to the precision of the expression, the criteria and conditions of exclusion and the differential diagnosis.

You say psychiatry is accurate. On the contrary, because I don’t see any fractures or high pressure values, they seem incomprehensible to me.

Psychiatry has a fairly precise vocabulary. You need to pay close attention to every word you say. If you’re giving something in black and white and diagnosing someone, you have to be specific. You cannot shoot from the passport so as not to make an erroneous simplification, error or complicated assumption, or psychologizing absurdity that has no justification. Everything has to be backed up with evidence and moreover it has to be in line with what the patient is suffering from and how they can be helped.

A psychiatric diagnosis can always be a sticker that puts you at a greater disadvantage at work than stomach ulcers. Do you consider every word?

I will speak for our workplace. I think we are very careful and cautious. Precisely because we are aware of the possible effects. But it is true that psychiatrists tend to be attacked for not being so careful, for example, from families and so on. You know, a psychiatrist has to talk, he can’t tell the court I don’t know, I don’t want to… But when he says he’s mentally healthy, he has to defend it, he has to be able to defend it . And it’s the same thing when he says someone’s mentally unwell.

How do you deal with these pressures? We are sitting in your office and the phone is ringing, relatives are calling. I suppose, for example, that a patient whose existence is suspended in your opinion will probably be as persistent…

It’s much more exhausting than looking after patients. But that’s part of the job. How can I handle it? Maybe well, I call it “changing modes”. Like when you have a car and drive in eco mode for a while, sometimes in sport mode. I just switch roles, both professional and personal. I take care not to confuse them with me. Which, of course, sometimes happens.

This probably applies to all of us, keeping the different worlds, professional and personal, a little apart.

Yes, it’s easy to say, but it’s wrong. I don’t think it’s strict, but you can try. And when it comes out one day, it’s fine.

I know you don’t like simplistic lifestyle advice on how to stay mentally fit and find your inner self, etc. What professional and life motivation does the head of psychiatry have in front of her?

This answer will be trivial. I want to continue doing research, taking care of patients, maintaining the good reputation of the clinic, teaching. This is the professional part. And personal? Always able to get excited about something and rejoice as a child, to indulge the whims of life. Without regret. And learn new things. I have a lifelong dream to learn German. It will be my defense against dementia and it will be a difficult thing because I have no talent for languages. Learning difficult things is the only meaningful brain exercise. You don’t train your brain with crossword puzzles, that’s nonsense.

As?

You have to do new things that are difficult for you. You do a lot of things automatically with crossword puzzles, the brain needs hard things to do. Overcoming obstacles is exhausting and fun, but it brings us the most satisfaction.

Klara Latalova (* 1970)

Graduate of the Faculty of Medicine of UP, Head of the Department of Psychiatry of the Faculty of Medicine and University Hospital of Olomouc, Professor in the field of Psychiatry. Author of several monographs (including Bipolar Affective Disorder, Aggression in Psychiatry), editor of several detailed monographs and co-author of three psychiatry textbooks. She has published over 120 professional articles. She is a member of several national and international professional societies, such as the Society for Biological Psychiatry, the Czech Neuropsychopharmacological Society, the Psychiatric Society of the Czech Medical Association JEP and the American Academy of Clinical Psychiatrist. She is a member of the editorial board of Remedia magazine.

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